Advice on abdominal pain.

[MrBrown]

Hmm lets see

10ml of salty water or 2mg of morphine .... which to choose, which to choose?

You know what, hey mate, this stuff we're going to give you might cause some really funky dreams, just go with it OK?

*Brown looks around for the nearest set of hands, you there, Smash type person, get Brown a pack of dextrose .... and put that down that ambophone the MAS Metro Clinician doesn't want to hear about crazy Brown again today!

 

[usalsfyre]

Yeah it would have been better than nothing, but with onset time anywhere from 10-30 minutes, for IM, he would be at ER to get IV morphine within that time.

Call and ask for permission to nebulize 10mgs of morphine.

 

[Smash]

Call and ask for permission to nebulize 10mgs of morphine.

This. AND give him the 10mg IM, he might not thank you now, but he will in 10 minutes time.

 

[Melclin]

I was sitting on a recliner at like 6 am with a copy of tintinalis and it wasn't much help, so I thought, I'll ask those clever chaps and chapettes on the interwebs. Like I said, I wasn't looking for a high level convosation and diagnosis, just a few light thoughts. Something like, "Yeah not sure, umm, well look for this and that and you know what, problem x jumps out at me" OR "Oh sudden onset LUQ pain with vomiting? Classic problem Y". Cheers to mycrofft, ratmedic and burdett, gave me a few things to think about.

With the sudden onset with vomiting, I thought something along the lines of malory-weis but it didn't seem to fit in terms of how the pain was presenting and there was no haematemesis.

+1 on pain management in abdo pain. Aside from the fact that its obviously inhumane to withhold, even in my short time in the job I have seen how patients are so much easier to accurately assess with some pain relief on board. Especially the doubled over abdopain. I had a bloke with a ?fractured rib the other day who couldn't remember any medical hx or meds and could barely tell us what happened for the pain even with 30mg of self administered oxycodone on board. He was so poorly communicative that it would have been easy to think it was abdo pain...and if you couldn't morph abdo pain.....:wacko:

Anyway 200mcq IN fent and 12.5 morphine later, we had a perfectly comfortable and communicative pt almost free of pain and easy to assess.

BTW - NIBP is used on every case in the OR in the US. We don't even have a manual cuff if we wanted one. They are very reliable, and the better quality machines are very good at dealing with motion artifact. Almost nobody auscultates blood pressures anymore.

Yeah its not NIBP in general I have a problem with. Its just some of the ones on our monitors. They seem to error with any movement and are frequently quite different to the manual pressure.

I think maybe they aren't calibrated as often as they should or maybe they get knocked about a bit. In any case my experience with them has not been great.

I take the view that the first pressure should be manual and then you can set the NIBP to q-whatever and as long as its consistent then its all good in the hood.

 

[rhan101277]

Call and ask for permission to nebulize 10mgs of morphine.

Yeah I would hear crickets on the other line once I asked something such as this. Though it would be hilarious to do so.

 

[mycrofft]

Thanks Melclin!

Sitting here in a cheap office chair and typing advice at people in the field can be SO unrewarding sometimes....B)

On reflection, go ahead and slow that gut motility. Not doing anything constructive and it can be restarted anytime at the hospital.

And remember, when you hear footfalls, think emus, not ostriches, mate.

 

[usalsfyre]

Sitting here in a cheap office chair and typing advice at people in the field can be SO unrewarding sometimes....B)

On reflection, go ahead and slow that gut motility. Not doing anything constructive and it can be restarted anytime at the hospital.

And remember, when you hear footfalls, think emus, not ostriches, mate.

I get the sarcasm, but are you advocating NO pain management for abdominal issues? Because even after fairly major abdominal surgery (involving the gut) my wife got opiates, so the motility argument holds very little water.

 

[mycrofft]

Nope, not sarcasm. Just retracting my earlier suggestion.

Gut motility, which can be retarded with opioids, is a diagnostic factor, but I realized after subsequent replies I was wrong about needing to serially auscultate them. Auscultate BS's as part of initial exam, then do whatever it takes to achieve analgesia; in many cases, the peristalsis may actually be harmful if there is possibility of gut contents escaping somewhere, or it is just fruitlessly (pun unintended) ramming gut contents against a mass or other blockage, or an intussusception.

So, the short answer is, no, I am not suggesting we let people writhe for our diagnostic convenience. I was wrong.:blush:

(PS: my better half had Roux-en Y, and yes, they ordered APAP wi. codeine susp. Yummy...).

 

[WelshMedic]

Pain management

Hello all,

First off, re: the blue rinse with tummy pain, did you do a HCG test? Ectopic pregnancies are easily missed, you know

Sorry, I can't help myself. Now into serious mode:

I recently suffered a very bad bout of food poisoning with abdominal cramps. Due to the nature of the complaint I was taken to hospital by my own colleagues. My painscore was initially 10+ (come on, I'm a man) but after some alfentanyl from my colleague it went down to a 2. It made a world of difference to me, I went from climbing the walls to a chilled state in about 2 mins. It also made me think about the importance of pain management in my own practice. And yes, now that I have been on the other end of the sitck, if they say it's 5 or more they get decent analgesia from me.

To withhold analgesia is just plain cruel. And has an effect on mortality and morbidity.

Carl.