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

[Yummymedic05]

I like to give patients the choice of IM or IV. For example I had a patient that slid into a base during softball. Obvious ankle/tib/fib. Patient did not want an IV (even though surgery was in order), but I gave the choice of something IM before we moved him. He refused, but after moving him, he wanted an IV with pain meds. People like choices so I let them choose.

We carry morphine, 1-10mg at our discretion, and Nubain 5-10mg IM. Nubain is for a morphine allergy and I have yet to utilize this drug.

[BushyFromOz]

Entonox i feel is a seriously underused drug at the basic levels of pre-hospital care

[AZCEP]

I wish I had Entonox available, but the weekly checks were getting out of hand.

I've had similar experiences to what you relate, Dust. I have to say that I'm willing to take a lot of heat from "experts" if I can get a thank you from the patient that was in pain, and is now relatively comfortable. I've even gone so far as to try to discuss things intelligently, but those discussions usually end up in the toilet. :roll:

[akroeze]

Just a random question I have been wondering about...

Pain patches, would they be effective prehospital? Like putting a fentanyl patch on someone experiencing ACS... would this actually do anything or would it be too long for onset?

[ericenglund]

Just a random question I have been wondering about...

Pain patches, would they be effective prehospital? Like putting a fentanyl patch on someone experiencing ACS... would this actually do anything or would it be too long for onset?

I really am not sure, but I heard those take too long to kick in on your typical prehospital run(not your 6 hour transfer or anything)

[scratrat]

Wow... that is simply unacceptable. Where in New Jersey? Is that still the rule??

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.

[flight-lp]

Sux to be in Jersey! Fortunately, pain management is one of our medical directors top priorities. Fentanyl 2mcg/Kg. PRN or Morphine 2-5mg PRN, no max on either (unless they are drooling on themselves), and Nitrous Oxide PRN. I usually have happy patients upon arriving at the ER..........

[scratrat]

Sux to be in Jersey! Fortunately, pain management is one of our medical directors top priorities. Fentanyl 2mcg/Kg. PRN or Morphine 2-5mg PRN, no max on either (unless they are drooling on themselves), and Nitrous Oxide PRN. I usually have happy patients upon arriving at the ER..........

Yes, it did.

[croaker260]

Here is our protocol:

(Available at: http://www.adaweb.net/departments/paramedics/swo/m12.pdf)

(Complete Set availble at: http://www.adaweb.net/departments/paramedics/swo2006.asp)

SECTION: M-12

PROTOCOL TITLE: Adult Pain Control and Sedation

REVISED:15 April 2006

GENERAL COMMENTS: Ada County EMS is committed to the relief of suffering in

its patient population. Accurate and standardized evaluation of the pain is an essential

component of pain management. Assessment should be on the 0 → 10 scale whenever

possible, using OPQRST as an assessment tool, to provide a quantitative level of

discomfort and allow accurate documentation. Providers at all levels should take a multifaceted

approach to pain control and sedation.

BLS SPECIFIC CARE: See adult General Medical Care Protocol M-1

- Treat underlying injury or illness as appropriate.

- Consider that proper splinting may either exacerbate or relieve pain, use good

clinical judgment in deciding course of action.

- Assist patient in maintaining position of comfort.

- Use distraction (through conversation, etc) and breathing techniques to help

patient alleviate pain.

- Ice packs or similar cold therapy for swelling.

ILS SPECIFIC CARE: See adult General Medical Care Protocol M-1

ALS SPECIFIC CARE: See adult General Medical Care Protocol M-1

Analgesia- Morphine Sulfate

IV/IM: 2-5 mg, repeated every 5-10 min PRN to a max of 20 mg.

- Fentanyl Citrate (Sublimaze)

IV/IM: 25-50 mcg IVP

Repeat every 5-10 min PRN to a max of 200 mcg

Sedation for painful procedures and injuries

- Midazolam (Versed)

IV/IM: 0.5-2.5 mg repeated every 5-10 min PRN to a max of 5 mg.

- Diazepam (Valium)

IV/IM: 2-5 mg repeated every 5-10 min PRN to a max of 10 mg.

- Etomidate (Amidate)

IV: 0.15 mg/kg slow IVP

For use in very brief, painful procedures where the pain response is

expected to be significantly reduced post procedure. (e.g.

Cardioversion).

Must be prepared to intubate if needed.

Spasms

- Midazolam (Versed)

IV/IM: 0.5-2.5 mg repeated every 5-10 min PRN to a max of 5 mg.

- Diazepam (Valium)

IV/IM: 2-5 mg repeated every 5-10 min PRN to a max of 10 mg.

Adjunctive medications: These medications are given for their potentiation of other

drugs effects, or for the prevention/treatment of certain side effects (nausea, etc), of

drugs used in pain control or sedation.

- Phenergan (Promethazine)

IV: 6.25-12.5 mg slow IVP, diluted.

IM: 12.5-25 mg

May dilute as needed for patient comfort when giving IV.

- Benadryl (Diphenhydramine)

IV/IM: 25-50 mg

PHYSICIAN PEARLS:

ALS Providers may decrease the dosage, or prolong the administration intervals of any

medication with sedative properties when doing so would decrease adverse effects and

still likely obtain the clinical goal.

Regarding Abdominal Pain: Narcotic analgesia was historically considered

contraindicated in the prehospital setting for abdominal pain of unknown etiology. It was

thought that analgesia would hinder the ER physician or surgeon's evaluation of

abdominal pain. It is now becoming widely recognized that severe pain actually

confounds physical assessment of the abdomen and that narcotic analgesia rarely

diminishes all of the pain related to the abdominal pathology. It would seem to be both

prudent and humane to "take the edge off of the pain" in this situation with the goal of

reducing, not necessarily eliminating the discomfort. Additionally, in the practice of

modern medicine the exact diagnosis of the etiology of abdominal pain is rarely made on

physical examination. Advancement in technology and availability has made laboratory,

x-ray, ultrasound, CT scan, & occasionally MRI essential in the diagnosis of abdominal

pain. Therefore medication of abdominal pain is both humane and appropriate medical

care.

[fade:fbdd84d3f4]Like our protocols and approach to medicine? Hiring in June! www.adaparamedics.org[/fade:fbdd84d3f4]

[scope2776]

- Etomidate (Amidate)

? IV: 0.15 mg/kg slow IVP

? For use in very brief, painful procedures where the pain response is

expected to be significantly reduced post procedure. (e.g.

Cardioversion).

Wow, cool, etomidate for cardioversion? Have you ever used it? I noticed you also have versed. I've always heard versed as being the superior choice for cardioversion... have you been able to compare either?

Your etomidate pain relief dose is almost our RSI dose (0.2mg/kg).... that's kinda sad....

Thanks for the great responses!