Can the scale be generalized for adults? I thought we were talking about adults seeking narcotics (legitimately or not). Are there any verifiable quantifiable measures of pain for adults- if we're not trusting Wong-Baker and changes to VS?
[Separated] Give drugs to drug seekers
- Thread starter DrankTheKoolaid
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Can the scale be generalized for adults? I thought we were talking about adults seeking narcotics (legitimately or not). Are there any verifiable quantifiable measures of pain for adults- if we're not trusting Wong-Baker and changes to VS?
A large amount of the evidence is from children, but it is easily adaptable to adults.
Look at the posts here, if you saw somebody in visible distress, you are basically using the FLACC scale whether you realize it or not.
Distracting injury, facial grimace, preoccupation with pain, etc.
If you use 1-10 scale it is subjective to the patient. (I admit I probably over medicate, but relieving pain has been fundamental to medicine since its inception.)
If you use simply clinical signs or opinion, you are using your subjective findings instead of the patients subjective findings.
Faces, FLACC, etc, were designed for children you could not ask. But nothing stops adapting these scales for at least some level of objectivity.
DesertMedic66
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That is the practice that I have been trying to say the whole time lol.
the_negro_puppy
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By withholding we are not try to cure them of their habit, we are removing the incentive for them to abuse EMS. Why should we hand out narcs like candy if the Emergency Departments at hospital don't?
18G
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We don't hand em out like candy.
Don't use a hospital as the perfect example. They are sometimes guilty of denying effective pain and nausea relief. In fact, I prefer to medicate onboard my unit because who knows how long it will be until they get relief in the ED. Especially if the patient get's a nurse or doc who doesn't look at pain and nausea relief as anything important.
Shishkabob
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So, here's the question to those of you who say our job is not to decide who's in pain, but to treat it.
Where's the line, or is there even one, for you? Does 1/10 pain get narcotics? What about a papercut when someone demands transport? Part of a chip being stuck between a tooth and gum for the better part of 9 hours?
Where's the line, or is there even one, for you? Does 1/10 pain get narcotics? What about a papercut when someone demands transport? Part of a chip being stuck between a tooth and gum for the better part of 9 hours?
WuLabsWuTecH
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I actually like the flush. You do it anyway when starting a line with a lock, so you tell them you're giving them saline and then ask if it helps with the pain. If it does, then you don't need to give them heavier stuff. You can always give them more saline. And yes, you do document it in the PCR. It shows that the pain could be just psychological/anxiety induced, or that they are seeking drugs. It's pertinent information.
bcemr
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Follow protocols. 10/10 pain? Treat with drugs.
God/Muhammed/Jesus/Their life- will judge them. That's not our moral or ethical job.
IMO.
God/Muhammed/Jesus/Their life- will judge them. That's not our moral or ethical job.
IMO.
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So does only 10/10 pain get analgesics? I'm with Linuss; where's the line drawn for pain management? Obviously situational, but you need to use judgement. Personally, if they state they're in mild to moderate pain I will give them the option, informing them of pros and cons. If they're in obvious severe pain, it's pretty much a given that they're getting something unless they straight-up oppose (which doesn't often happen). If they are known drug seekers that show no real physical manifestations of pain, I'll be much more hesitant to offer anything.
DrParasite
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my back hurts, it's giving me 10/10 patient. I'm going to travel to your system and call 911, since I want some pain meds.
so does my left toe, because I kicked a curb in 12 degree weather.
I hope i get a paramedic who will give me IV pain meds, since my pain is 10/10.
Remeber343
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"My back hurts, 10/10, I need 2 mg dilaudid. That is the only thing that helps. Please, dilaudid". Good times.
Melclin
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I'm president and founding member of the local 'give morphine to everyone' club. One of my preceptors said jokingly to me once after he refused pain relief to some idiot, that I would have tickled her feet (a reference to part of my neuro exam) and given her ten of morph but hell would have frozen over before I gave her oxygen ^_^
None the less, I have a line and everyone should. On the scale of no pain to agony, the first step for me is suggesting everyday OTC analgesia, regardless of if we're transporting. Then comes methoxyflurane. I realise this is not an option for most people on this board but it is a great bridge to more lasting analgesia and it is also great for people who don't require morphine or fent which are our only other two options currently, but are still in pain. The spontaneously resolving dislocations that will get a couple of acetaminophen/codeine preps and other such not so nasty kinds of pain are good examples of this. Also works a treat with kids.
Then after that its a case by case basis. Two questions I frequently ask are, "Could you sleep with this pain" and "do you want anything more (more than the methoxy or panadol) for the pain". I instruct them not to be stoic and I observe their outward signs of pain. How they handle going over bumps with things like ortho trauma also factor into it. The number scale really doesn't mean to much to me and I often don't even bother asking. Cardiac chest pain is the only kind of pain I routinely use it with. Otherwise I simply give pain relief until they say they're comfortable. Obviously these aren't methods to weed out drug seekers, but I don't really need to because its not too much of a problem here. This is how/why I don't give 20mg morphine to a paper cut but still consider myself aggressive with pain relief.
bcemr
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I hope so too.
Shishkabob
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You'er an EMR, correct? What sort of medications do you have for pain control? Do you ever have to make the decision, BEYOND "Because protocols said so", as to who gets sufficient pain relief?
Guess what, my protocols state I am to use my clinical experience to make decisions, as not every patient fall within set protocols.
Says who? My job is to treat my patient in the way I decide is best for the situation at hand.
Snowing someone simply because they grab a number out of thin air is not it.
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"On a scale of 1-10, where 10 is the worst pain you've ever felt in your life, how badly does it hurt?"
"10"
"What's the worst pain you've ever felt?"
Sometimes, that's actually a useful question. Also, sometimes I do wish our medics would be a bit more aggressive in their pain relief. Then again, that requires them to open the narc bag, and fill out paperwork, and I suppose for some of them, that's just too much to ask.
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DrankTheKoolaid
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re
Snowing someone and offering and administering analgesics for valid pain complaints is two totally different things. It's unfortunate how many newer people I meet and talk to in EMS have a jaded view of pain management they most like obtained by working with medics who felt pain control wasnt a medics job. Then again 5 - 10 minute eta's = glorified IV starters and not practicing paramedicine.
Consider this the next time you have a patient with a valid pain complaint. What would you do with a family member with the same complaint, lets say your mother daughter or spouse. Would you also withold analgesics? What would you expect out of another medic treating your loved ones?
And for the answer for everthing types. Would you consider analgesics any sooner with a real red~head or some other other ethnicity before you would on a caucasion
Snowing someone and offering and administering analgesics for valid pain complaints is two totally different things. It's unfortunate how many newer people I meet and talk to in EMS have a jaded view of pain management they most like obtained by working with medics who felt pain control wasnt a medics job. Then again 5 - 10 minute eta's = glorified IV starters and not practicing paramedicine.
Consider this the next time you have a patient with a valid pain complaint. What would you do with a family member with the same complaint, lets say your mother daughter or spouse. Would you also withold analgesics? What would you expect out of another medic treating your loved ones?
And for the answer for everthing types. Would you consider analgesics any sooner with a real red~head or some other other ethnicity before you would on a caucasion
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Shishkabob
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And we go back to my question, that you refused to answer... Stubbed toe, 10/10. Papercut, 10/10. Piece of food stuck in gum, 10/10. Do you give pain control to them to the point of getting rid of the pain to their satisfaction? If not, you're a hypocrite. If so, you're a cookbook medic. So which is it? Or will you relent and state that not everyone in pain, needs pain controlled by us in the field, and that it IS our job to decide who gets what?
Go back through my posts over the last 3 years. I'm a huge advocate of analgesia, and love giving Fentanyl... but just because you say "Ow" and give me a number doesn't mean you're getting medicine from me. The medicine has to match the complaint, and vice versa. Most medics are too stingy, yes, but that doesn't mean we aren't to use our brains in the matter either. I don't judge if someone is in pain, however, I do call in to question how much, and if I can't defend it, I'm not giving it.
Heck yes I'd treat my family with analgesics. Guess what? I'll also give my family $1,000 before I give some random person $1,000 when they say they are broke.
Go back through my posts over the last 3 years. I'm a huge advocate of analgesia, and love giving Fentanyl... but just because you say "Ow" and give me a number doesn't mean you're getting medicine from me. The medicine has to match the complaint, and vice versa. Most medics are too stingy, yes, but that doesn't mean we aren't to use our brains in the matter either. I don't judge if someone is in pain, however, I do call in to question how much, and if I can't defend it, I'm not giving it.
Heck yes I'd treat my family with analgesics. Guess what? I'll also give my family $1,000 before I give some random person $1,000 when they say they are broke.
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I have learned, through many years of working in different environments, malingering is an equal opportunity enterprise...
As others have said, some amount of judgement must be displayed. I'm just about as hard line as they come about pain management. Doesn't mean if I'm picking you up for the sixth time in two weeks for vague non-specific pain and we've hit a different ED each time I'm handing out narcs.
If you decide to (by being clinically negiligent) withhold pain meds in the field, the pt is just going to employ the "squeaky wheel" tactic and get the ED to get them high anyway. How many drunks, junkies or psych pts have you brought into the ED, nice and calm during txp, who flip out, scream bloody murder, and kick/punch everyone as soon as they're in triage? My record is four in one night. The pt knows that if they become violent, they'll be tied down and medicated, no matter what. I've seen it too many times.
I'd also hate to be the one who is wrong that one time about withholding pain meds, and then gets investigated for negligence, risking disciplinary action, being fired, or risk losing their card.
I'd also hate to be the one who is wrong that one time about withholding pain meds, and then gets investigated for negligence, risking disciplinary action, being fired, or risk losing their card.
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DrankTheKoolaid
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Re-read my post, i said VALID complaint. I am totally for paramedics using their judgment if it is sound judgement and not a bias.
usalsfyre I asked that question for a reason and obviously you didn't know it so I will just direct you to some light focused reading and you can find out for yourself why I asked the question regarding red-heads and other ethnicities.
Sota Omoigui's Anesthesia Drugs Handbook - You can learn alot from reading what a world renowned expert has to say about pain control and various pain tolerances between ethnicities and even between Caucasian traits