Als dispatch for possible Appendicitis

[bigdogems]

Well seeing how there is so much concern about possible rupture. Now that you loaded your pt up with narcotics hope that they have someone who can give consent if they need surgery.

 

[LondonMedic]

Well seeing how there is so much concern about possible rupture. Now that you loaded your pt up with narcotics hope that they have someone who can give consent if they need surgery.

Seriously?

So, not only would you be unable to use an appropriate amount analgesic but you would actively withold pain relief from someone (someone who is willing to be treated by you) on the grounds that they might be required to sign a form in the next few hours.

That sounds cruel and unusual to say the least.

 

[njemtbvol]

allow me to clarify

If the pain was LRQ medics would have been called.
Hospital is about 5-7 mins away l/s
I ask the pain scale the may my instructor taught me. As 1 is a normal headache, 10 I'm actively cutting off limbs with a chainsaw.

Als is about 4-5 mins out.

 

[bigdogems]

From everything I've seen I have to say the UK has some very different ways things are done. But as a standard I've never worked anywhere that narcotic pain management was used in acute abd pain. Ortho injuries sure. But for how many possible things could cause abd pain I rather let the doc do his exam without pain being masked by pre hospital pain management. Im not sure about the UK but "pain control" has been pushed so much in the US that people have come to expect that they shouldnt ever have to have pain. I have seen countless pts with 10/10 abd pain yet they are eating a bag of chips when the get to the waiting room or can sleep perfectly comfortable

But for the OP. No, if working in a system that has both ALS and BLS it would be acute abd pain and be a BLS response. When in a system that has limited ALS units sending them to abd pains would probably completely overload the system

 

[LondonMedic]

From everything I've seen I have to say the UK has some very different ways things are done. But as a standard I've never worked anywhere that narcotic pain management was used in acute abd pain. Ortho injuries sure. But for how many possible things could cause abd pain I rather let the doc do his exam without pain being masked by pre hospital pain management.

This has been shown, time and again, to be unacceptable practice. Good analgesia actually enables a proper assessment and allows the clinician to take a clearer history and elicit signs on examination. If someone is too busy screaming or writhing on the trolley then none of this is possible.

Read the Cochrane Review.

Im not sure about the UK but "pain control" has been pushed so much in the US that people have come to expect that they shouldnt ever have to have pain. I have seen countless pts with 10/10 abd pain yet they are eating a bag of chips when the get to the waiting room or can sleep perfectly comfortable

Then that is part of managing people's expectations and that is as important a comms skill as taking a history or breaking bad news.

 

[STXmedic]

From everything I've seen I have to say the UK has some very different ways things are done. But as a standard I've never worked anywhere that narcotic pain management was used in acute abd pain. Ortho injuries sure. But for how many possible things could cause abd pain I rather let the doc do his exam without pain being masked by pre hospital pain management.

Then you should reevaluate the places you've worked at. I'm in Texas also, and have never worked in a system that doesn't allow narcotics for abdominal pain. I won't go into why as London said it fairly well.

 

[Flight-LP]

Then you should reevaluate the places you've worked at. I'm in Texas also, and have never worked in a system that doesn't allow narcotics for abdominal pain. I won't go into why as London said it fairly well.

Thanks for the interjection.

Bigdog, studies have proven that acceptable analgesia in the pre-hospital environment has ZERO effect on most consent concerns. It is nothing more than an excuse.

I agree with poetic, you may need to look at the systems you are associated with, especially since the one in your own hometown has some of the most liberal pain guidelines around.

 

[mycrofft]

Search pre-hospital analgesia.

hat debate cvhanged my mind in favor of it.

Original post:

We had a discussion today down at the squad building about whether Als should be sent out for a possible appendicitis.An acute abdomen is an acute abdomen. Put down the video game or dominoes and go.

The pt. chief was complaint was a stabbing pain the lower left quadrant.
Internittent or steady or worsening or stable , sudden onset or insidious and over how long...go see the pt, its safer and quicker. Don't have the pt do a rebound test over the phone.

I've had every one of my relatively few appy cases recall pain in locations besides McBurney's beforehand, but the overwhelmingly greater pain there was thought by them to be different. Also, most complained of queasiness before the pain settled down and right*.

10/10 no radiation.
I think that abdo pain "refers", not "radiates", usually.

The silver lining here is that the majority of LLQ pain is related to stool or/and gas so some of those delayed pts may have gotten lucky, but the belly is a wonderous and dangerous place, as one of my instructors told us.


*As a healthy adolescent, mine started m idline with slight nausea, then LLQ, then RLQ.

 

[18G]

ALS for pain and nausea management.

 

[medicsb]

If the pain was LRQ medics would have been called.
Hospital is about 5-7 mins away l/s
I ask the pain scale the may my instructor taught me. As 1 is a normal headache, 10 I'm actively cutting off limbs with a chainsaw.

Als is about 4-5 mins out.

As has been mentioned pain is subjective. You will encounter patients who will rate their pain 10/10 (even if you try to calibrate them with a 1= X, 10=Y approach) but will pick up their cell phone to call and yell at their kids or make jokes with you while another patient may rate a pain 8/10 and be rocking back and forth, crying, grunting, with an elevated RR and HR.

You need to look for objective signs of pain, too. Grimacing, difficulty concentrating or answering questions due to distraction by the pain, vital sign changes (e.g. incr. HR, RR, BP), splinting, guarding, etc., etc.

 

[systemet]

It seems that in EMS we have some sort of idea that we have to identified "drug-seeking" individuals, and with-hold narcotics from them. Or that by giving a random citizen a small dose of IV morphine, we're risking creating a raging heroin addict, if we get them even the slightest bit euphoric.

I would argue that most of the behaviour we label as "drug-seeking" is actually people who are anxious, and having a little bit of a hard time coping with life in general.

I think if you're a true addict, and you're going through withdrawal, maybe 5mg of morphine is worth calling EMS for, to "take the edge off". I don't think we're going to be getting anyone who is even a little bit tolerant of opiates high off the doses we give prehospitally under most circumstances.

[Consider for example, pain management in cancer patients --- I once received an order of 30 mg MS IVP, from a palliative care physician for a patient with breakthrough pain. These patients are opiate tolerant, but how much more tolerant is a drug addict?]

I had a family member once present to the ER with an acute abdomen, and be labelled as a drug seeker. Possibly because he's a little bit of a borderline personality. He has trouble communicating well, and at 0300 may have appeared to fit the "drug seeking" demographic. And he got to sit there for several hours until someone finally did some imaging, while the staff treated him like crap. I would rather give opiates to a hundred "drug seekers", and take the edge off a few people's opiate addictions, than try judging how much my patients "deserve" opiates, and miss a single patient who genuinely needs pain control. I'd rather have a high false-positive rate than see this happen.

 

[abckidsmom]

It seems that in EMS we have some sort of idea that we have to identified "drug-seeking" individuals, and with-hold narcotics from them. Or that by giving a random citizen a small dose of IV morphine, we're risking creating a raging heroin addict, if we get them even the slightest bit euphoric.

I would argue that most of the behaviour we label as "drug-seeking" is actually people who are anxious, and having a little bit of a hard time coping with life in general.

I think if you're a true addict, and you're going through withdrawal, maybe 5mg of morphine is worth calling EMS for, to "take the edge off". I don't think we're going to be getting anyone who is even a little bit tolerant of opiates high off the doses we give prehospitally under most circumstances.

[Consider for example, pain management in cancer patients --- I once received an order of 30 mg MS IVP, from a palliative care physician for a patient with breakthrough pain. These patients are opiate tolerant, but how much more tolerant is a drug addict?]

I had a family member once present to the ER with an acute abdomen, and be labelled as a drug seeker. Possibly because he's a little bit of a borderline personality. He has trouble communicating well, and at 0300 may have appeared to fit the "drug seeking" demographic. And he got to sit there for several hours until someone finally did some imaging, while the staff treated him like crap. I would rather give opiates to a hundred "drug seekers", and take the edge off a few people's opiate addictions, than try judging how much my patients "deserve" opiates, and miss a single patient who genuinely needs pain control. I'd rather have a high false-positive rate than see this happen.

Amen.