# What kind of analgesic do you use?



## HMartinho (Oct 4, 2011)

What kind of analgesic do you use? Here in Portugal, I saw medical professionals using tramadol, morphine sulfate and fentanyl, but recently I saw a nurse using propacetamol IV. As I had never seen this analgesic, I questioned her and she told me that propacetamol was much safer to use in the prehospital environment, than the narcotic analgesics. What do you think?


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## johnrsemt (Oct 4, 2011)

We have Fentanyl  (my preference), Morphine and Demerol.


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## HMartinho (Oct 4, 2011)

But you never seen someone using propacetamol? It is a safe drug?


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## fast65 (Oct 4, 2011)

Here we use either morphine or Stadol (butorphanol tartrate)


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## Shishkabob (Oct 4, 2011)

HMartinho said:


> But you never seen someone using propacetamol? It is a safe drug?



Is Acetaminophen / Tylenol a safe drug?  As far as drugs go, typically yes.  As far as "safer" than a narcotic: No.  Drugs are as safe as you make them.  Every single medication can kill someone.  She's obviously part of the "OMG narcotics cause respiratory depression therefor they are unsafe!" crowd.







In the US, you generally have Morphine and Fentanyl.  Some agencies might go a bit further, but those 2 are the most common.  Infact, you'll see Morphine/Fentanyl/other narcotic anagelsics than you will NSAIDs, IV or otherwise.


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## HMartinho (Oct 4, 2011)

Linuss said:


> Is Acetaminophen / Tylenol a safe drug?  As far as drugs go, typically yes.  As far as "safer" than a narcotic: No.  Drugs are as safe as you make them.  Every single medication can kill someone.  She's obviously part of the "OMG narcotics cause respiratory depression therefor they are unsafe!" crowd.
> 
> 
> In the US, you generally have Morphine and Fentanyl.  Some agencies might go a bit further, but those 2 are the most common.  Infact, you'll see Morphine/Fentanyl/other narcotic anagelsics than you will NSAIDs, IV or otherwise.



The point is that I always saw acetaminophen oral or rectal use, never I.V. as given by the nurse.

In my view, I do not believe that propacetamol I.V. is as effective as tramadol, morphine or fentanyl.


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## bigbaldguy (Oct 4, 2011)

Were there any contraindications to use of opiates in this particular patient? Is it possible he/she might have been a drug seeker and the nurse was trying to avoid giving him a reason to come back? I've seen hospital staff bend over backwards to avoid giving opiates to drug seekers for this reason.

By giving it IV maybe she was trying to give the patient the impression that he was getting the "good stuff".


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## epipusher (Oct 4, 2011)

Fentanyl.


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## bigbaldguy (Oct 4, 2011)

Sorry never answered OP's original question.

We carry Morphine, Fentanyl, and Toradol. I've never seen the Toradol used but I assume we carry it for kidney stones.


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## HMartinho (Oct 4, 2011)

bigbaldguy said:


> Were there any contraindications to use of opiates in this particular patient? Is it possible he/she might have been a drug seeker and the nurse was trying to avoid giving him a reason to come back? I've seen hospital staff bend over backwards to avoid giving opiates to drug seekers for this reason.
> 
> *By giving it IV maybe she was trying to give the patient the impression that he was getting the "good stuff"*.




Good point of view. 

There is no indications that the patient was addicted. He had suffered a car accident. He had an open fracture of the left tibia, and was slightly hypovolemic, which was the reason we call an imeddiate life support unit, where the nurse start an I.V. line, began the fluid replacement, and given intravenous acetaminophen.


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## 18G (Oct 4, 2011)

Morphine,  Fentanyl. And Dilauded if sent by sending facility.


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## Chief Complaint (Oct 4, 2011)

Morphine and Fentanyl.


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## NomadicMedic (Oct 4, 2011)

At my current service, fentanyl only. 




Sent from my iPhone.


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## MrBrown (Oct 4, 2011)

Volunteers have paracetamol, entonox and some have methoxyflurane 

Paramedic's have all of the above plus morphine

Intensive Care Paramedics have all of the above plus morphine+low dose midazolam and ketamine.

Prior to 1990 we had entonox with some Advanced Care Officers (old name for Intensive Care Paramedic) being authorised to use nubain and foratol; then we got very low dose morphine in 1990.  In 1999 we got morphine for selected Intermediate Care Officers (old name for a Paramedic) then in 2001 morphine+midazolam was introduced for Intensive Care, 2007 we got ketamine for ICPs.  Ketamine is awesome stuff, seen it used with great results many times.

There was some talk around 2009 of replacing morphine with fentanyl but last I heard it wasn't happening.


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## Wes (Oct 4, 2011)

Where I am right now, we have fentanyl and our benzos are midazolam and diazepam. We're supposed to be getting lorazepam next and possibly getting morphine back. (Apparently several of the local cardiologists still prefer it.)

My last service carried fentanyl and demerol for pain management. Benzos were midazolam, diazepam, and lorazepam. Toradol for kidney stones.  Ketamine was also an option for certain patients.


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## Handsome Robb (Oct 4, 2011)

We use fentanyl first choice then morphine sulfate. Only time we really use MS is in ACS events.

They just took nitronox out of our protocols, we never really used it anyways.

We have midazolam and diazepam for benzos.


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## Chief Complaint (Oct 4, 2011)

MrBrown said:


> Volunteers have paracetamol, entonox and some have methoxyflurane
> 
> Paramedic's have all of the above plus morphine



Interesting.  Is that common in your country for volunteers and career staff to use different drugs?  If so, why?


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## Shishkabob (Oct 4, 2011)

NVRob said:


> They just took nitronox out of our protocols, we never really used it anyways.



I'd prefer Nitronox over Fent / Morphine in the vast majority of patients anyhow.


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## systemet (Oct 4, 2011)

HMartinho said:


> Good point of view.
> 
> There is no indications that the patient was addicted. He had suffered a car accident. He had an open fracture of the left tibia, and was slightly hypovolemic, which was the reason we call an imeddiate life support unit, where the nurse start an I.V. line, began the fluid replacement, and given intravenous acetaminophen.



I have zero experience with IV tylenol/acetaminophen/paracetamol.  I've only ever given it po/pr, mostly to febrile kids.

I would agree that the maximal analgesic effect of tylenol is substantially less than that of morphine or fentanyl.

I can understand opting for fentanyl instead of morphine, if there's a concern that the patient may be hypotensive due to unidentified injuries as a result of significant multisystem trauma.

I could see using acetaminophen if there was some contraindication to other available analgesics.  But it seems grossly inappropriate for an open extremity fracture if opiate/opiod based options are available.

* Disclaimer, it's hard to second guess someone else's decision making process when they can't defend themselves.


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## HMartinho (Oct 4, 2011)

systemet said:


> I have zero experience with IV tylenol/acetaminophen/paracetamol.  I've only ever given it po/pr, mostly to febrile kids.
> 
> I would agree that the maximal analgesic effect of tylenol is substantially less than that of morphine or fentanyl.
> 
> ...



Yes, I understand. 

I also do not want to counter the nurse "clinical judgment" . She knows more than me, I'm just an EMT-B. Just thought it weird because I never seen anyone using IV paracetamol / proparacetamol


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## Smash (Oct 4, 2011)

To add to systemet's comments, another reason I could see to use an IV NSAID would be if it is being used as an adjunct, to provide combination analgesia. This would make sense for the patient with fractures, but I certainly wouldn't use it on it's own. 

As for us, morphine, fentanyl and ketamine (but only on the Whirlybird at this stage).


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## Flight-LP (Oct 4, 2011)

Fentanyl, Dilaudid, Ketamine, Ice / heat, Ibuprofen, APAP, and Toradol.


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## Handsome Robb (Oct 4, 2011)

Linuss said:


> I'd prefer Nitronox over Fent / Morphine in the vast majority of patients anyhow.



I agree, especially for isolated extremity injuries. It works fine and takes a bit of the workload off the medic seeing as it is an Intermediate skill here rather than making any patient who gets analgesia an ALS patient. The argument I have heard against it is that if it isn't effective in controlling the patient's pain some medics are afraid to load narcs on top of it since the patient's GCS could be below our threshold for narcotics. GCS < 13, but they'd really have to gork themselves out on the Nitronox to get to that point, in my experience at least.

Technically it is still in our protocols but we don't carry the equipment anymore  We may still have them available for Special Events Intermediates, I need to check. They printed the books before they decided to pull the equipment off the rig.


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## mikie (Oct 4, 2011)

*Why does MIEMSS hate us?*

We have a _*huge arsenal*_ of analgesic options in Maryland: 

-Morphine (changed to a weight-based dose this year)

-Tylenol PO for minor to mild pain, recently added (last yearish); how often do i/have i seen it used? once.  

-Norm Alsaline for the drug seekers (jk )


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## Handsome Robb (Oct 4, 2011)

I forgot, we have PR Acetaminophen but we only use it for febrile pediatric patients.


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## MrBrown (Oct 4, 2011)

Chief Complaint said:


> Interesting.  Is that common in your country for volunteers and career staff to use different drugs?  If so, why?



No, medicines are defined by scope of practice

All Ambulance volunteers now complete the National Diploma in Ambulance Practice which gives them the BLS (EMT) practice level.

I said volunteers because now to reach Paramedic you need a 3 year degree and Intensive Care Paramedic is two years experience as a Paramedic plus a further graduate qualification; there is also rumor of paid BLS Officers being phased out, so there may come a time when there are no paid BLS Officers.


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## FFEMT427 (Oct 5, 2011)

In the USA I don't think that anyone uses acetaminophen IV (at least not prehospital). OFIRMEV which is IV acetaminophen was FDA approved recently. I read a study a while ago and I can't for the life of me remember what it was called I beleve it took place in France in which they compared paracetamol to morphine. I can't really see many good reasons to use acetaminophen prehospital for pain. I agree that in some cases PO analgesia would be useful. 
As to the use of toradol it is a great med and gives use one more tool in our tool box to bring some comfort to our patients and when used in combo with other treatments makes for very effective pain management.


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## 325Medic (Oct 5, 2011)

Fentanyl and Morpine. Benzos are Versed and Valium (awaiting Ativan).

325.


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## the_negro_puppy (Oct 5, 2011)

Morphine
Methoxyflurane (inhaled)
Paracetamol

about to get Fentanyl


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## HMartinho (Oct 5, 2011)

the_negro_puppy said:


> Morphine
> Methoxyflurane (inhaled)
> Paracetamol
> 
> about to get Fentanyl



Your paracetamol can be used by I.V. line?


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## the_negro_puppy (Oct 5, 2011)

HMartinho said:


> Your paracetamol can be used by I.V. line?



Negative, sorry forgot to specify, oral paracetamol


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## RatMed (Oct 5, 2011)

In Poland for paramedics it's morphine and ketoprofen.
Ambulance docs use much wider variety which includes also: fentanyl, pethidine, tramadol, metamizol and paracetamol.


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## jjesusfreak01 (Oct 8, 2011)

Technically paracetamol, toradol, and nitronox are within my scope as a (soon to be) intermediate in NC, however we don't carry Nitronox, we generally only give toradol for kidney stones, and paracetamol is used primarily for fever reduction and rarely for pain. To that end, pain management tends to be done only at a paramedic level with narcotics.


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## Basermedic159 (Jan 31, 2012)

HMartinho said:


> Yes, I understand.
> 
> I also do not want to counter the nurse "clinical judgment" . She knows more than me, I'm just an EMT-B. Just thought it weird because I never seen anyone using IV paracetamol / proparacetamol



NEVER say your " JUST an EMT-B" You went to school for your EMT just like everyone else did. Have you ever heard a medic say "I'm just a medic",?
The answer is probably no. Look at a medic patch and see whats in front of paramedic ( *EMT*-Paramedic) We're all EMT's, but it's up to you to be an outstanding EMT, or "just an EMT-B"


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## R99 (Jan 31, 2012)

MrBrown said:


> There was some talk around 2009 of replacing morphine with fentanyl but last I heard it wasn't happening.



Somebody needs to read the new clinical guidelines, have you done CCE yet? Fentanyl is here for Paramedic and above but morphine is bring kept also 




Wes said:


> Where I am right now, we have fentanyl and our benzos are midazolam and diazepam. We're supposed to be getting lorazepam next and possibly getting morphine back. (Apparently several of the local cardiologists still prefer it.)



Remember that benzodiazapines are.not analgesics but may be used to intensify their effects and lightly sedate the patient


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## STXmedic (Jan 31, 2012)

Basermedic159 said:


> NEVER say your " JUST an EMT-B" You went to school for your EMT just like everyone else did. Have you ever heard a medic say "I'm just a medic",?
> The answer is probably no. Look at a medic patch and see whats in front of paramedic ( *EMT*-Paramedic) We're all EMT's, but it's up to you to be an outstanding EMT, or "just an EMT-B"



I say "I'm just a medic" all the time. It's called understanding your limitations. Just because you went to school like everybody else doesn't mean your educations are even close to equal, and that you don't ever need to punt your patient.

Oh, and there's no EMT in front of Paramedic anymore


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## triemal04 (Jan 31, 2012)

Basermedic159 said:


> NEVER say your " JUST an EMT-B" You went to school for your EMT just like everyone else did. Have you ever heard a medic say "I'm just a medic",?
> The answer is probably no. Look at a medic patch and see whats in front of paramedic ( *EMT*-Paramedic) We're all EMT's, but it's up to you to be an outstanding EMT, or "just an EMT-B"


My patch doesn't say EMT anywhere on it.  Hasn't for some time now.  That's also true for many, many paramedics.

I say "I'm only a paramedic" somewhat often.  I hear it from other paramedics as well.  In fact, I even hear doctors say (to paraphrase) "I'm just a XXX doctor, I sent them to XXX for a reason.)  Insert whatever specialty you like there; heard it from plenty.

I know what I know, and have a pretty good idea how much I don't. (hint; it's a lot).  Saying "I'm just a XXX" doesn't mean that you are denigrating yourself or what you do, just that you are aware of the limits of your knowledge and know when it's time to look for help.

I'd rather have someone be honest with me than try and come up with some BS answer because they didn't want to be seen as "just a paramedic."

But...if you want to prance around pretending to be supermedic (or superemt) go for it...


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## Basermedic159 (Feb 1, 2012)

triemal04 said:


> My patch doesn't say EMT anywhere on it.  Hasn't for some time now.  That's also true for many, many paramedics.
> 
> I say "I'm only a paramedic" somewhat often.  I hear it from other paramedics as well.  In fact, I even hear doctors say (to paraphrase) "I'm just a XXX doctor, I sent them to XXX for a reason.)  Insert whatever specialty you like there; heard it from plenty.
> 
> ...


^^^
 I would like to commend you on taking that comment completely out of context, twisitng it aorund to fit your own agenda at a failed attempt to make sense to yourself and be some type of know it all you claim, not to be. : )


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## Handsome Robb (Feb 1, 2012)

Basermedic159 said:


> ^^^
> I would like to commend you on taking that comment completely out of context, twisitng it aorund to fit your own agenda at a failed attempt to make sense to yourself and be some type of know it all you claim, not to be. : )



I didn't see anything taken outta context, but that's just my opinion.

We use fentanyl for analgesia mainly. Morphine in ACS and abdominal pain. In my very limited experience it seems to work better for abdominal pain than fentanyl.


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## Aidey (Feb 1, 2012)

Basermedic159 said:


> ^^^
> I would like to commend you on taking that comment completely out of context, twisitng it aorund to fit your own agenda at a failed attempt to make sense to yourself and be some type of know it all you claim, not to be. : )



I would like to commend you on bumping multiple old threads to throw mini hissy fits about how awesome EMTs are and how we Paramedics need to remember where we came from. If you have a bone to pick, start a new thread. But stop bumping old threads for no reason other than to exercise your ego.


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## Basermedic159 (Feb 1, 2012)

Aidey said:


> I would like to commend you on bumping multiple old threads to throw mini hissy fits about how awesome EMTs are and how we Paramedics need to remember where we came from. If you have a bone to pick, start a new thread. But stop bumping old threads for no reason other than to exercise your ego.



Again, you dont know me nor my level. Exercise my ego? More like exercise my opinion, which clearly enough is not wanted from anyone who hasn't been a member for a while.

I guess the "new" people should agree with what all the "senior" emtlife members say.


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## NomadicMedic (Feb 1, 2012)

Basermedic159 said:


> Again, you dont know me nor my level. Exercise my ego? More like exercise my opinion, which clearly enough is not wanted from anyone who hasn't been a member for a while.
> 
> I guess the "new" people should agree with what all the "senior" emtlife members say.



Yikes. You're not making any friends here. 

Since it seems like you didn't get the message, in this forum, it's considered bad form to bump a post to add a comment that simply agrees or disagrees with the previous post. 

I think everyone is open to your opinions, but if you temper the bombast a bit and start new threads (or comment on current topics) I'm sure you'll be welcomed a bit more warmly than you have been.


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## Aidey (Feb 1, 2012)

It has nothing to do with who is new or who is senior. It has to do with the fact that you are being incredibly obnoxious. You are bumping old threads for no reason but to start debates about something no one is arguing about but you. Look around, you'll notice that people disagree with each other all the time. The difference is that the rest of us are debating topics using evidence to back up our positions. What you are doing amounts to throwing temper tantrums because of perceived insults to EMT-Bs.


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## Tigger (Feb 1, 2012)

Basermedic159 said:


> Again, you dont know me nor my level. Exercise my ego? More like exercise my opinion, which clearly enough is not wanted from anyone who hasn't been a member for a while.
> 
> I guess the "new" people should agree with what all the "senior" emtlife members say.



A couple hours ago you're training did not have the P suffix. So what is your level?


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## Basermedic159 (Feb 1, 2012)

Tigger said:


> A couple hours ago you're training did not have the P suffix. So what is your level?



I put it in there to let everone know i'm not a basic. I didnt know that it really made a difference. But I guess it dose. My level is (NC) EMT-P.

Let me add to this post by saying I in no way trying to be rude, offensive or otherwise unpleasant by my previous posts. I just have a different way of saying things, that might be misconstrued as me being arrogant, which is not the case.


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## Tigger (Feb 1, 2012)

Basermedic159 said:


> I put it in there to let everone know i'm not a basic. I didnt know that it really made a difference. But I guess it dose. My level is (NC) EMT-P.
> 
> Let me add to this post by saying I in no way trying to be rude, offensive or otherwise unpleasant by my previous posts. I just have a different way of saying things, that might be misconstrued as me being arrogant, which is not the case.



I find it useful to know who I'm talking to, others mileage may vary. 

I'm not going to get into how you express your posts, besides the fact that many community members have already stated how you come across. Not breaking rules does not automatically mean you're operating in good taste.


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## Basermedic159 (Feb 1, 2012)

Tigger said:


> I find it useful to know who I'm talking to, others mileage may vary.
> 
> I'm not going to get into how you express your posts, besides the fact that many community members have already stated how you come across. Not breaking rules does not automatically mean you're operating in good taste.



I understand and I will put forth the effort to express my posts in a less condecending manner. I don't want people to think that's who I am. Like I said if I've offended anyone, I do apoligize. If everyone could actually hear the things that I post instead of me typing it, it wouldn't come across that way. I'll do my best to communicate better with everyone, in such a way not to seem like an a$$ because I'm really not.


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## Basermedic159 (Feb 1, 2012)

I also didn't quite understand the terms such as "bumping" and things of that nature. I am still learning about threads, posting etc...


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## Mountain Res-Q (Feb 1, 2012)

Tigger said:


> A couple hours ago you're training did not have the P suffix. So what is your level?



Watching with amusement on all these threads.  Ever recognize that history repeats itself on EMTLIFE; usually every 3-6 months... 

But I've got $20 on "16 y/o First Responder Student."


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## Basermedic159 (Feb 2, 2012)

Mountain Res-Q said:


> Watching with amusement on all these threads.  Ever recognize that history repeats itself on EMTLIFE; usually every 3-6 months...
> 
> But I've got $20 on "16 y/o First Responder Student."



:rofl: I've got a NC "p" number that says different.


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## NomadicMedic (Feb 2, 2012)

Basermedic159 said:


> :rofl: I've got a NC "p" number that says different.



And again... Nobody cares. We've got docs, RTs, medics with decades of experience and plenty of other knowledgable folks here, all sharing information without pounding their chest and showing off their certs and degrees. 

I suggest READING posts for a week or two, get to know the players by the info they post, and then jump back in. 

And FYI, "bumping" a thread is when you reply to s thread that is weeks (or months) old, to add nothing substantive. It's highly frowned on. Almost as much as asking a question that's been answered 100 times prior, like, "what stethoscope should I buy?"

So again, my advice is lay low, read the threads... Then come back and join in. 

Good luck...


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## Basermedic159 (Feb 2, 2012)

n7lxi said:


> And again... Nobody cares. We've got docs, RTs, medics with decades of experience and plenty of other knowledgable folks here, all sharing information without pounding their chest and showing off their certs and degrees.
> 
> I suggest READING posts for a week or two, get to know the players by the info they post, and then jump back in.
> 
> ...


Appearantly someone cared, thats why I changed it. The I was questioned about it, also showing that somone cares therefore I told them.

I am not bumping my chest etc etc etc. I've never said I know everything and everyone else is stupid.

I'm really working on my people posting skills so please lets leave it at this,

Thanks.


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## Tigger (Feb 2, 2012)

n7lxi said:


> And again... Nobody cares. We've got docs, RTs, medics with decades of experience and plenty of other knowledgable folks here, all sharing information without pounding their chest and showing off their certs and degrees.



I have to admit that I do care a bit about our member's certifications. For instance, you're a medic so if I ask a question about narcotic pain management, I am more likely to take a greater interest in your answer than say a basic's (which I am) answer, since you have more knowledge about the topic at hand. That said, I don't think someone's lack of training should ever preclude them from posting in a topic. I know I post in "ALS Topics" despite not being a real ALS provider because I am curious and just want to learn for my own knowledge. Plus, it's usually obvious when someone doesn't know what they're talking about.


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## NomadicMedic (Feb 3, 2012)

Tigger said:


> I have to admit that I do care a bit about our member's certifications. For instance, you're a medic so if I ask a question about narcotic pain management, I am more likely to take a greater interest in your answer than say a basic's (which I am) answer, since you have more knowledge about the topic at hand. That said, I don't think someone's lack of training should ever preclude them from posting in a topic. I know I post in "ALS Topics" despite not being a real ALS provider because I am curious and just want to learn for my own knowledge. Plus, it's usually obvious when someone doesn't know what they're talking about.



I agree, but I also don't post, "I'm a medic, so I know more than you do." I have a friend who is a volunteer EMT on a BLS ambulance, but works as a PharmD at a large hospital. She knows a LOT more than I do about pharm, and I love to pick her brain about the prehospital drugs we use, and how thing are different in the hospital. 

At any rate, people should be free to post, ask questions, share anecdotes and experiences... Just a civil, respectful attitude is what we all deserve.


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## Basermedic159 (Feb 3, 2012)

n7lxi said:


> I agree, but I also don't post, "I'm a medic, so I know more than you do." I have a friend who is a volunteer EMT on a BLS ambulance, but works as a PharmD at a large hospital. She knows a LOT more than I do about pharm, and I love to pick her brain about the prehospital drugs we use, and how thing are different in the hospital.
> 
> At any rate, people should be free to post, ask questions, share anecdotes and experiences... Just a civil, respectful attitude is what we all deserve.



I read this whole thread again, and I haven't seen anywhere where it said "I'm a medic, so I know more than you do." ?


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## Tigger (Feb 3, 2012)

Basermedic159 said:


> I read this whole thread again, and I haven't seen anywhere where it said "I'm a medic, so I know more than you do." ?



It doesn't. Not all comments in this thread are directed at you. The point I was trying to make is that many of us appreciate knowing the background of the member's of this site. As a general rule on this site, it is frowned upon to talk down to another member just because you (non-specific) hold a higher certification or more training than another member. Not saying this is occurring here, but it has in the past.


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## MedicMey (Feb 4, 2012)

Well. I am just a new paramedmedic, but we have morphine and fentanyl. My last service also had Toradol, used mostly when we suspected a kidney stone.


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## Veneficus (Feb 4, 2012)

NVRob said:


> I didn't see anything taken outta context, but that's just my opinion.
> 
> We use fentanyl for analgesia mainly. Morphine in ACS and abdominal pain. In my very limited experience it seems to work better for abdominal pain than fentanyl.



Shouldn't that be reversed?:sad:


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## jjesusfreak01 (Feb 5, 2012)

I propose the training sigs of all members be changed to "Parathinktheyare"


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## Handsome Robb (Feb 5, 2012)

Veneficus said:


> Shouldn't that be reversed?:sad:



What be reversed? 

It is n=1 but in the small amount of experience I have the analgesic along with euphoric effects of MS seem to work a bit better in abdominal pain, especially in pain originating in the hollow organs. I won't pretend to understand it but my guess would be because of the slowing of gastric motility and peristalsis, but again that's just my theory. I've been so damn busy I haven't had the motivation to go find studies to support this or tell me I've totally gone off the deep end


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## Veneficus (Feb 5, 2012)

NVRob said:


> What be reversed?
> 
> It is n=1 but in the small amount of experience I have the analgesic along with euphoric effects of MS seem to work a bit better in abdominal pain, especially in pain originating in the hollow organs. I won't pretend to understand it but my guess would be because of the slowing of gastric motility and peristalsis, but again that's just my theory. I've been so damn busy I haven't had the motivation to go find studies to support this or tell me I've totally gone off the deep end



sounds reasonable to me, I was just thinking about all of the things that hurt more when smooth muscle contraction is inhibited


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## HMartinho (Feb 5, 2012)

Basermedic159 said:


> NEVER say your " JUST an EMT-B" You went to school for your EMT just like everyone else did. Have you ever heard a medic say "I'm just a medic",?
> The answer is probably no. Look at a medic patch and see whats in front of paramedic ( *EMT*-Paramedic) We're all EMT's, but it's up to you to be an outstanding EMT, or "just an EMT-B"



I think you do not understand the meaning in my words. I mean, when I say "I'm just an EMT-B", I am not denigrate my position, and I know all my abilities and difficulties. I'm very proud to be an EMT-B. However, my course of 210 hours, including rotations in the ED, ICU and resuscitation room, I learned very little about pharmacology. On the other hand, a pre-hospital nurse had a fine of hundreds of hours of training in pharmacology. So yes, she knows more than me about pharmacology, and I respect that.


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