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Do You Feel You Have the Ability To Adequately Control Pain?


scope2776

Can you adequately control your patients pain?  

33 members have voted

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    • Yes
      21
    • No
      12


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I so totally agree! They won’t let people who are willing and more than capable to learn how to give basic analgesia but there more than happy to staff a MX event with 400 riders or a major speedway meetting with level 2 first aid officers and a fishing tackle box.

Do you have any idea how hard it is to get a license to administer basic analgesia if you’re not a health care professional? Australia has things so very wrong lol

Timmy, what state/service are you a member of? I think you are generalising/stereotyping here (alot)! Australia is not as backward as you make out!!

I work in NSW and have the following analgesics at my disposal:

Methoxyflurane (Penthrane) - inhaled

Fentanyl - intra nasal

Morphine - iv or im

and for orthopaedic injuries or severe muscular pain (ie. lower back pain) can use a combination of Morphine/Fentanyl and Midazolam (iv) to achieve adequate analgesia (I know Midazolam is not an analgesic).

Very rarely will I take a patient into an ED still in significant pain.

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Timmy, what state/service are you a member of? I think you are generalising/stereotyping here (alot)! Australia is not as backward as you make out!!

I work in NSW and have the following analgesics at my disposal:

Methoxyflurane (Penthrane) - inhaled

Fentanyl - intra nasal

Morphine - iv or im

and for orthopaedic injuries or severe muscular pain (ie. lower back pain) can use a combination of Morphine/Fentanyl and Midazolam (iv) to achieve adequate analgesia (I know Midazolam is not an analgesic).

Very rarely will I take a patient into an ED still in significant pain.

Hey sladey67,

I live in rural Vic.

I’m a sports trainer with pronominally a football club as well as doing a few other jobs here and there. I also work with a Motocross club privately. Our MX track is a good 45mins for the ambulance to arrive on an urgent call and depending on were we play football it can be up to 2 hours away. From what I’ve heard it’s pretty easy to carry Penthrane in NSW because of the worksafe insurance? But in Vic if you’re not working with RAV/MAS or you’re a medical officer then you can pretty much forget about it.

I know a paramedic who also works with a football club, under the sports medicine insurance all he can do different from the rest of us is take a BP.

3 of us at MX have a Cert IV in Emergency Medical Response which covers Inhaled Analgesia and Medication Administration but in Vic there is no insurance to cover us.

The motorcycling vic insurance states they only need Level 2 first aid officers to run a motocross event and only a national championship requires paramedical care. So basically last weekend we covered an MX event with 4 first aid officers with 400 riders and the ambulance 45mins away and even then the ambulance is only 1 up, you could only imagine the sorts of trouble we were having. This is why I’m a bit worked up.

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Well I think your biggest problem then would be a lack of high level or care at the event and lack of adequate staffing. I understand what you are saying, it would be nice to help with the pain, but that involves starting an IV, and if you aren't able to take a bp you shouldn't be giving pain meds in the first place. I think you should worry more about getting an ambulance that can transport the patient to definitive care and less about being able to administer medications. Also why can you not take a bp ? That seems stupid.

For the original post, our ALS trucks carry morphine for pain management. We also have valium and versed for sedation, not for pain though.

Our standing orders for morphine is 1-3 mg q 5 prn to max of 10 mg, or 0.1 mg/kg to a max of 10 mg. Then its medical control for higher doses.

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We have standing orders for fentanyl and morphine for isolated extremity trauma, burns and suspected cardiac pain. But these are very recent and we are so glad to have them. Had this question been asked 6 months ago I would have answered no due to no standing orders and frequent low doses ordered by MC when you actually did call in, 2 mg's of MS isn't shit when someone just had a hand chewed up in an auger.

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G’day Timmy

Sounds like someone needs a hug from Captain Cuddles!

I know it must be extremely frustrating but unfortunately that’s the way the cookie crumbles in Victoria. If you don’t work for a service that doesn’t have insurance for S4 drugs then there is not much you can do. Pretty much the only way in Vic to get an S4 license is if you work for the state service or get a prescription from a Medical Officer (which is extremely hard to get your hands on) or your service has a Medical Director who can authorize a prescription. It doesn’t matter if you have a masters degree in analgesic administration, it would make no difference.

Unfortunately Victoria doesn’t have a set standard for Event Medical Care, so it really comes down to what the organizer can afford and what their independent insurance says.

Keep your head up little buddy. Keep working hard, you’ll make a bloody good paramedic one day. Just remember, all good things come to those who wait.

As for the original question. We could give Morphine, Fentanyl, Lignocaine, Penthrane. Theres a few others but those were the main ones. For sedation we gave Midazolam, Pancuronium, and Suxemethonium

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Unless they changed it in the past 8 months, it's still the same. And it is statewide. You cannot administer any narcotics without doctors orders.

It's still the same. Luckily, when I call the Doc-In-the-Box, I usually get what I want. However, I don't do pain management that often, because unfortunately, most of the time it's a seeker. However, I seem to be developing my sense of real vs. seeker.

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Uh yeah, that's because narcotics can be dangerous. Of course you have to be a healthcare professional, it only makes sense. As a basic I know I wouldn't feel comfortable administering MS etc.

Since when did pain relief belong solely to the domain of the narcotic?

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Morphine is the only true pain reliever we have here, and a Medical Control option at that.

It's also an optional med, as are Valium and Versed, and also phenobarb for medics.

As optionals, we don't carry them. Cost money, you know. :roll:

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25mg is a pretty low dose still but better than 12.5

I guess I'm speaking from a surgical Nurse background and not a field perspective. 50mg minimum.... frequently 100mg. Do you also automatically mix in an anti-emetic with it?

Basically every patient I ever had would have 50mg Demerol and 50mg Gravol PRN as a minimum.

Yes it is low. But thats if I want to do it immediately without talking to a doctor. I can call and ask for more, and every time I do, I get what I want. It's usually 100-200 depending on the injury and size/age of the pt. They are fairly liberal with it, but I don't use it very often, because the large population is seeking. I have been developing a way of telling the difference.

And no, we don't automatically give it with a anti-emetic. We can get orders for phenergan, but I'm not a big fan of it. Seen the article of the medic being sued because she obviously didn't realize the line was bad and gave phenergan? The women wound up getting her arm amputated. If I'm giving any pain management or phenergan, I ensure it's an 18g or better and unless contraindication, I'll run between 50-100 cc's just to sure it's a patent line.

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It's still the same. Luckily, when I call the Doc-In-the-Box, I usually get what I want. However, I don't do pain management that often, because unfortunately, most of the time it's a seeker. However, I seem to be developing my sense of real vs. seeker.

Thankfully our doctors got to know your voice and associated it with a face when you brought your pt in. Most of the docs, once they got to know what you are capable of, will give you what you want. That said, I have had problems getting orders for pain control. They do not like us snowing pts up there for pain management. I've had isolated fractures, with nothing else going on (at least not that I had evidence of), and they still refused. Narcs for MI's and such was easy to get.

Everyone looks at me funny down here when I say "Doc-in-the-box". Like they've never heard that phrase???

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