Pain Control

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HotelCo

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I was in a situation today where I had no means of pain control to help with a radius & ulna fracture. Nada. Nothing.

So, what do you do in situations like this? Deep breathing? Focusing on something else? Reassurance?
 
Did you try O2 therapy?

One blow to the head with the tank and they are unconscious and no longer in pain.
 
akflightmedic said:
Did you try O2 therapy?

One blow to the head with the tank and they are unconscious and no longer in pain.
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Ba dum chush!

Thank you, thank you. Be sure to tip your waitress and try the veal!
 
Can I ask, I have found out why ye dont use Entonox, but is there a reason EMT's/paramedics in the states dont use Penthrane Inhalers?


I still cant imagine a frontline ambulance with no pain relief...
 
Scout said:
Can I ask, I have found out why ye dont use Entonox, but is there a reason EMT's/paramedics in the states dont use Penthrane Inhalers?


I still cant imagine a frontline ambulance with no pain relief...
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Hence a reason why BLS should NOT be a frontline ambulance
 
akflightmedic said:
Did you try O2 therapy?

One blow to the head with the tank and they are unconscious and no longer in pain.
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Damn you! I was coming in to say that in those exact words!

That said, there are certain things you can do. Positioning and restriction of movement will do most of it. Splint it up good, tie it down to the patients chest as tight as you can without it being uncomfortable or shutting down circulation. Pad around it and underneath it, like a folded sheet between his chest and slung up arm and a pillow on his lap and holding his arm up. Tell your driver to take it easy on turns and over potholes. If you're really good, there are certain pressure points that you can crank on to block a certain amount of pain. By "certain amount" I mean "Not nearly freaking enough." But they do work to block some pain, though the pressing into them causes a decent amount of discomfort in THAT location too.

As weird as it sounds, try to keep your patient distracted. Some people respond well to jokes, just being goofy. Some, however, get angry that you're "making light" during their extreme pain. You have to feel around for the best response.

We mostly do the positioning for breaks. Like I said in a previous thread (and was lambasted for), we hardly do any pain meds in my area as we are less than fifteen minutes from a hospital no matter where we are in the city. Only times I did pain meds so far was a particularly bad case of sickle cell, a fracture that resulted in a partial amputation.
 
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It's one of those things i picked up in martial arts and a couple veteran medics. Not exactly medically approved of course, for an arm I'd say it's about the same as when you whack your "funny bone." You just have to compress the nerve hard enough to interrupt sensation. It doesn't work every time, it only works for a few minutes, and it doesn't alleviate all that much pain to be honest.

A large part of it is actually a psychosomatic response. You tell people that "...this may help..." and they may convince themselves that it is.

Keep in mind, you may want to check with your medical director to see if you're even allowed to explore this avenue of "treatment," as it's not exactly hard medicine.

As far as the "Why no pain meds," it's something I've been questioning more and more since my last conversation regarding that here at EMTLife. The typical answer is that we are so close to a hospital no matter where we are, it's not worth the time, and that the Docs in the ED prefer to have a "clean" patient so they can get a proper assessment of the pain that they're dealing with. Personally, I am buying that less and less. If someone is having a cardiac issue, we give nitro, in part, to help reduce pain (yes, I know the PRIMARY reason we give it...) So already their "pain" is going to be reduced when they get to the ER Doc anyway. And in cases of burns, breaks, and other traumas, I don't see why pain would matter as a broken leg is a broken leg, no matter how well the patient is dealing with the pain.

Right now, I'm still a student and trying not to rock the boat too much, but it's something that I plan on questioning on my way up the chain.
 
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Good splinting does work some. There's also a reason why the old standby of "RICE" treatment works. Cryotherapy (ice) slows down nerve conduction so you feel less pain. It also slows down cell metabolism. Because of the nerve conduction slowdown and the slower metabolism, you'll also see less muscle spasming... which is a natural splint... but that spasming also causes the bone ends to grate together... which increases soft tissue damage and increases pain...
 
Akulahawk said:
Good splinting does work some. There's also a reason why the old standby of "RICE" treatment works. Cryotherapy (ice) slows down nerve conduction so you feel less pain. It also slows down cell metabolism. Because of the nerve conduction slowdown and the slower metabolism, you'll also see less muscle spasming... which is a natural splint... but that spasming also causes the bone ends to grate together... which increases soft tissue damage and increases pain...
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What he said.

Why didn't I think of suggesting ice? Jeez, I go through ice packs like they're candy...
 
Remember the basics... ;)

Good old ice is cheap and quite effective... Just don't overdo it.

You could say that I spent a good chunk of the last... 17 years or so learning how to prevent, recognize, and treat injuries...

I know ice & injuries...
 
Ice it till its pink is what I was taught (around 15 minutes or so).... worked great in Football season!!!!!
 
Here we'd at least be able to give entonox or methoxyflurane; best thing I could suggest is calling for advanced backup for pain relief
 
DV_EMT said:
Ice it till its pink is what I was taught (around 15 minutes or so).... worked great in Football season!!!!!
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There are several different ice protocols in use for pain relief... and it depends on the specific modality in use. Ice water is different from ice water in a whirlpool, which is different than an ice bag... as well as the body part you're going to chill down.
 
Distraction method. When we do D&Es in the OB-GYN clinic (can be quite painful as we routinely do them with simple local anesthesia and nothing else), my job is not only to pass instruments off to the MD and monitor the patient, I also chat up a storm with the patient. I warn them beforehand, "Just tell me if you want me to shut up," but then I ask a billion questions about their lives and converse with them... nothing too personal. I've never had a patient ask me to stop, they have always appreciated the distraction.

My attending told me she once had a patient ask to be sung to. The doc sang her a lullaby. It may be difficult to do on an ambulance when the pain is unplanned, but we've begun suggesting our patients bring Ipods to their procedure so they can listen to their music.

I also try to coach patient's breathing, much like you would with someone who is hyperventilating or experiencing an asthma attack. Patients in pain tend to hold their breath or breathe rapidly/shallowly.

If I have a medical student or resident handy, I have them offer the patient two fingers to squeeze (I typically can't do this as I'm busy passing stuff off) If you give them your whole hand they'll crush it, but even the burliest patients can squeeze your two fingers with all their might without causing you discomfort.
 
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LucidResq said:
Distraction method. When we do D&Es in the OB-GYN clinic (can be quite painful as we routinely do them with simple local anesthesia and nothing else), my job is not only to pass instruments off to the MD and monitor the patient, I also chat up a storm with the patient. I warn them beforehand, "Just tell me if you want me to shut up," but then I ask a billion questions about their lives and converse with them... nothing too personal. I've never had a patient ask me to stop, they have always appreciated the distraction.

My attending told me she once had a patient ask to be sung to. The doc sang her a lullaby. It may be difficult to do on an ambulance when the pain is unplanned, but we've begun suggesting our patients bring Ipods to their procedure so they can listen to their music.

I also try to coach patient's breathing, much like you would with someone who is hyperventilating or experiencing an asthma attack. Patients in pain tend to hold their breath or breathe rapidly/shallowly.

If I have a medical student or resident handy, I have them offer the patient two fingers to squeeze (I typically can't do this as I'm busy passing stuff off) If you give them your whole hand they'll crush it, but even the burliest patients can squeeze your two fingers with all their might without causing you discomfort.
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I've used that method myself. It works. Listening to favorite music does work pretty well. Pain tolerance/endurance has been studied in athletes... when they listen to music, they can go longer and harder before they have to stop due to pain than when they aren't listening to that distraction.

It is amazing how well the simple stuff works.
 
Fear amplifies pain. Especialy fear of pain.

Distraction and positive vibes and sincerity help, and the better you can fake it, the better it will work.
By the way, ever actually try pushing on one of your nerves hard enough to cut off sensation? In most instances it hurts like hell, and if you bruise the nerve it will hurt for a while.
 
mycrofft said:
Distraction and positive vibes and sincerity help, and the better you can fake it, the better it will work.
By the way, ever actually try pushing on one of your nerves hard enough to cut off sensation? In most instances it hurts like hell, and if you bruise the nerve it will hurt for a while.
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Cryotherapy's effects are much more transient... and hurts a LOT less. Cryotherapy is not a panacea though. Certain nerves can be damaged in a fairly short amount of time when exposed to cold.

Another case for knowing your modalities.
 
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mycrofft said:
Distraction and positive vibes and sincerity help, and the better you can fake it, the better it will work.
By the way, ever actually try pushing on one of your nerves hard enough to cut off sensation? In most instances it hurts like hell, and if you bruise the nerve it will hurt for a while.
Click to expand...

I wasn't suggesting squeezing it that hard. Just pop it over the bone enough to cause a little tingling/numbness to the area. Doesn't matter if it ACTUALLY stops pain (I honestly don't think it does), but people's response to it seems to be that of relief. I think they feel something unusual (well, unusual without whacking your funny bone) and think the medical guy just did some magic Mr. Miagi move to help their pain.
 
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