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

[katbemeEMT-B]

Unfortunately, it doesn't clear anything up. And, based on this, Dust's questions still stand.

If you understand the protocols you should know why they're there in their current form. So you've just contradicted yourself.

But maybe because you're sick? Hope you feel better. Being sick sucks.

-be safe

Okay, so let me start by saying this. Protocols of any kind, anywhere, are there ultimately to set a specific standard of care. They tell us as pre-hospital care personnel what our scope of practice is. They give us guidelines to follow to assist us in providing our patients with the best possible care with what we as a service has to work with. They are also there to protect the patient, EMS personnel, and MC doctor under which we provide service. The ultimate result of these protocols is hopefully to keep the patient alive.

While other areas may have more generous protocols they also have more to offer their patients, especially pain meds. As far as why they were implemented in they're current form; I would have to say refer to my statement directly above. These have been the protocols for many years. I am fairly new. My job is to provide care to my patients and part of that is knowing what our protocols are and understanding how they fit into "hands on" experience (sorry soggy brain won't let me think of a better way to say it). Why the administration decided to put them there does not affect how I do my job. I have an EMS director, EMS manager, and EMS personnel representative that takes care of those things. Some day when I take that step I will become one of those people and then it will be my job. In all honesty, I can't think of but maybe one medic and two emts that would have the answer to why they are there in their current form and that's because one is the EMS director (medic) and the other two have been with the service since it switched from a privately owned to hospital based.

I know, you think this is a cop out but right now I am concentrating on learning all I need to know to make me a great emt and am in the process of starting medic school (hopefully this fall). At that point I can concentrate on administration and work on changing things I don't feel are patient positive. Sitting in the position that I am now I would think they would just laugh at me. I'm not that funny either.

Let me know if I'm still missing the point because sooner or later the fog will clear and I will get a mind back.

[ERDoc]

Yep, exactly the same happens here in the UK. My point is I don't worry about medicating the 1 seeker in a hundred patients that I see. I cannot say that somebody isn't experiencing pain....only the patient can tell me that. If they say they have got pain, then they get pain relief in whatever form I feel necessary. Control of pain is important not only for humanitarian reasons but also because it may prevent deterioration of the patient and allow better assessment. Sure, they may be lying through their teeth or I may have my doubts about a person but at least I can say, hand on heart, that all my patients get adequate pain relief. As soon as you start becoming selective about who gets pain relief, innocent patients are going to lose out because you don't believe them.

Innocent people are not going to lose out. I have a low threshold for meds. Again, with enough experience you know what is real pain and what is not. I'm not being selective about who gets meds, I am making sure that a pt is being treated properly. Medicine is about clinical judgement and that includes making sure you are treating pain, or the lack there of, properly. Narcotics are not without some nasty side effects. So why do I want to take the risk of exposing a person to these when clinically I do not feel the treatment is warranted? This include getting a person addicted to a medication. Do you want to be responsible for adding to someones addiction? There are numerous other ways to treat pain beside narcotics.

People usually ring an Ambulance because they have an acute problem which may be an acute exacerbation of a chronic illness. Having chronic pain doesn't mean that they don't deserve immediate pain relief before stabilisation of their condition and a review of their treatment plan and medication.

You are either very niave or have a very different pt population than we have here in the US. The are always drug seekers using an ambulance to get in the door. It gets them into a room quicker and they think they will be taken more seriously. There are few chronic conditions that we are able to stabilize in an ambulance or in the ER. What am I going to give to a person who is already on methadone, oxycontin, fentanyl patches and oral dilaudid? The only thing I can do is just dope you up to the point of unconsciousness. What pts with chronic pain need is a pain clinic who can manage their pain appropriately and not just throw narcotics at them. Before they get any narcs, their pain doc should be called so that you can develop an appropriate plan for the pt.

There are also two different kinds of pt we are talking about and I think you are getting them confused. There are people with chronic pain and then there are drug seekers. I have no problem giving meds to people with chronic pain. When you come in and tell me you are allergic to motrin, toradol, tylenol, morphine, benadryl, phenergan, reglan, compazine and droperidol, complain of a migraine that is 20 out of 10 (despite the fact that you are sitting there watching TV and laughing with your friends) and the only thing that works for your migraine is 2mg IV of dilaudid then yes, you will be labeled as a seeker. When you ask me for a script for vicodin or percocet for a .5cm superficial lac from a cat scratch to your cuticle and tell me that you will go to XY hospital because they will give you the script, then yes I will label you.

Yes, we do keep in mind the bigger picture of what will happen at the hospital, but it has no real influence on what interventions I perform pre-hospital. I assess and treat my patient on how they present at the time of my assessment (and re-assessment). It is of no concern to me what happens once I hand over.

If you do not let the big picture influence how you treat a pt then you truly do not grasp or keep in mind the bigger picture. We are talking about more than just what happens when you hand the pt over. We are talking about the impact on society as a whole. It may not seem like a big deal, but you are missing so much.

[ericenglund]

When you come in and tell me you are allergic to motrin, toradol, tylenol, morphine, benadryl, phenergan, reglan, compazine and droperidol, complain of a migraine that is 20 out of 10 (despite the fact that you are sitting there watching TV and laughing with your friends) and the only thing that works for your migraine is 2mg IV of dilaudid then yes, you will be labeled as a seeker.

Wow thats funny you should mention that, during one of my clinicals when I was in school I was in the ER and this woman did exactly that, except her list of allergies was a few shorter and she was doing a fairly good job of moaning and covering her eyes with a washcloth. The doctor kept giving her benadryl and... I want to say Haldol(memorys kinda fuzzy..pretty sure it was).. to which she had "no relief." after 3 rounds of that the doctor straight up told her he wasn't going to give her any narcotics. She sat straight up and started bitching about a patient advocate and then TORE her IV out and said she was going to a hospital about 20 minutes away and signed out AMA.

[letsgonational]

Yes' date=' we do keep in mind the bigger picture of what will happen at the hospital, but it has no real influence on what interventions I perform pre-hospital. I assess and treat my patient on how they present at the time of my assessment (and re-assessment). It is of no concern to me what happens once I hand over.[/quote']

If you do not let the big picture influence how you treat a pt then you truly do not grasp or keep in mind the bigger picture. We are talking about more than just what happens when you hand the pt over. We are talking about the impact on society as a whole. It may not seem like a big deal, but you are missing so much.

I'm really glad you posted this. In Williamsport, PA we currently carry morphine and fentanyl. Our current is 4 of Morphine initially for anyone with pain (except for abdominal pain or severe trauma from MVA. Then most of us call command first). Morphine is repeated 1mg every 5 minutes; max dose of 12mg, decreased BP of 20mmHG, or ALOC. Most of us only use Morphine for cardiac or GI symptoms.

Fentanyl is 1mcg/kg, usually used for extremity fx/pain. Fentanyl is repeated @ 15 minute intervals at .25mcg/kg to a max of 3mcg/kg, decreased BP of 20mmHg, or ALOC.

As far as the quoted post, if you don't care about the big picture then why are you involved in EMS? The whole goal of EMS is to bring the ER to the pts home, workplace, MVA, etc...this means we're an extension of the emergency room. If you don't care about the "big picture" than I dont want you treating my family members. Your interventions set the tone for what happens to the patient in the emergency room. If you blow your patient off, than so does the ER staff. At least that's the way it is here. Paramedics here are highly regarded and if we do something, they know we did it for a reason. If you dont care about the big picture, get off the street. Its as simple as that.

[Dustdevil]

Our current is 4 of Morphine initially for anyone with pain (except for abdominal pain or severe trauma from MVA. Then most of us call command first). Morphine is repeated 1mg every 5 minutes; max dose of 12mg, decreased BP of 20mmHG, or ALOC. Most of us only use Morphine for cardiac or GI symptoms.

:?

[spenac]

:?

Dang it dust I agree with you again, more questions than answers.

[Dustdevil]

[ccmedoc]

A lot a that around here :shock: :? 8)

[ccmedoc]

ERDOC wrote: I also tell them that it would be inappropriate for me to treat their chronic pain with the 4mg of Dilaudid (which I feel is one of the worst drugs ever created) that they ask for.

I would like to respectfully ask why this statement..not a challenge, but for my own education

As it is not our job to tell a patient what pain is or if they are feeling it or not, I believe that after a reasonable assessment, any pain should be controlled, or at least be addressed. Pain is what the patient says it is, right? If a frequent flyer keeps calling or a patient presents with an allergy to all analgesics and narcan, then it may be inappropriate to treat this patient with narcs. We are not in the business of telling people they do not hurt and, just as it is poor practice to give narcotics away at the drop of a hat, it is very problematic not to treat or undertreat this complaint of pain.. Drug addicts have pain too :wink:

[BAYAMedic]

Who all carries nubain or stadol? i personally am allergic to Demerol and morphine doesnt do well unless its a huge dose, (6'3 275 lbs, With cronic Migraine) but a normal dose of stadol or nubain releives the headache. unfortunatly thats all they carry up here is morphine and demerol, i havent rode in a rig but once but it would be nice to have that other option available

Fireman1037