Actually, the opposite is true. You'll see significant elevations in aminotransferase levels in many people after just a few days taking 4 grams per day. And acetaminophen is associated with liver damage much more often than most people realize, which has actually led to calls on several occasions for it to be made a prescription-only drug. The problem isn't with the recommended doses of acetaminophen, it's with the fact that the drug is found in so many formulations. Sleep medicines, allergy medicines, cold medicines, prescription pain medicines, etc. It's not uncommon for someone to take Goody's powders along with with their Percocet (whether it was prescribed to them or not) and wash it down with some beers and top it off with some NyQuil. You do that for a few days in a row, especially if you are overweight or have other risk factors for hepatic injury, or are also taking NSAIDS or some of the antibiotics or 1000 other drugs that are also hard on your liver, and you have the start of a potentially very serious problem. Then you go to the ED and they give you a gram because of course you didn't admit to everything else you've been taking, and you can see where the problem lies. It takes as little as 7 grams (though usually twice that much) - which is only 14 extra strength Tylenols - to cause hepatotoxicity, and it can take a lot less than that when some of the aforementioned factors are added to the mix. Ibuprofen is less problematic than acetaminophen, but also deserves more respect than it generally gets. None of this means we shouldn't use these drugs, of course, just that we shouldn't be flippant about their presumed safety.It is my understanding that the liver toxicity of Tylenol is overrated, that you can take it everyday, just as long as you are not taking high doses (>1,000 mg every 6 hours or >3,000 or 4,000 mg per day).
Of course you can do whatever you want, but it's generally not a good idea to claim to be allergic to things you aren't actually allergic to. Not only does it make it sound as though you lack knowledge about your own health history (no one is "allergic to narcotics", and trust me, there are LOTS of scenarios where you don't only want NSAIDS), but it can cause problems for you in other ways. It's much better to just explain that you've had problems with nausea in the past. It's a common side effect of morphine, and generally easily managed.I told my parents that if something ever happens to me, just tell them I am allergic to narcotics and only want NSAIDs/Tylenol.
In the realm of longer transports, I absolutely agree. Of course, part of my bias against having EMS give these meds is that I'm primarily in an urban/suburban area with relatively short transports, maybe 10-15 minutes max for the vast majority of transports. This is also specifically for PO admin of these meds. If we include IV administration, I think IV APAP becomes an interesting option for both pain and fever control even in short duration transports. Same goes for Toradol.I do think that acetaminophen can have a place in EMS, especially for the treatment of fever or for pain in longer transports.
Temperature monitoring ought to be a skill that every transporting unit can perform - cheap and non-invasiveI've never understood why much of EMS just doesn't care about temperatures and fever control. I would like to have some tylenol available (we have longer transport times), but we need a real thermometer first I think.
NSAIDS can have hepatic consequences as well.Our protocols will soon include a choice of Ibuprofen or APAP for fever reduction and pain management
Assuming the agency will carry both which is your choice and why. I know there are hepato-tox issues with APAP. Would that rule it out
I'd turn the question around and ask why would you bother giving a drug that isn't very potent and takes an hour to reach peak effect, when you can give more potent drugs that reach peak effect within minutes?I never understood the idea that patients aren't going to see significant relief in the timespan of an EMS transport with PO meds. You're correct that they won't in the twenty minutes you spend with them, but that doesn't mean they won't get pain relief after you drop them off in the ED. Who cares if you aren't around to see the effect?
You make a fair point, and I guess I don't really have a great rebuttal to it. The best time to use NSAIDs and acetaminophen is probably when doing event medicine, which I think is not a terrible reason to add them to the scope of practice, given how common that is.I'd turn the question around and ask why would you bother giving a drug that isn't very potent and takes an hour to reach peak effect, when you can give more potent drugs that reach peak effect within minutes?
To be honest, in the EMS environment I am just not very concerned about the type of mild discomfort that OTC PO meds are appropriate for. If someone is in more pain than what I would expect a few ibuprofen to adequately manage, then I'll use a drug that I think is likely to get the job done. But if they aren't in enough pain to warrant fentanyl, then I think giving some ibuprofen or aspirin in the hopes that they'll feel a little better 20 minutes after I drop them off but which would then perhaps prevent the administration of better drugs, like celebrex or toradol (or worse yet, they get a double dose of NSAID) isn't a worthy tradeoff.
In many hospitals, a frequent source of med errors is patients getting all kids of meds in the OR, then getting to the floor and because the anesthesia charting is done on paper or in a system that doesn't communicate well with the rest of the hospital, they get IV toradol or ibuprofen when decadron and celebrex was just given preop a couple hours ago. There's just a lot of opportunity for details to get lost in the shuffle, and the same opportunity exists in the EMS:ED interface.
I'm not saying the risks are great - they aren't - but neither are the benefits. Given the limited ability of these meds to have much impact on the patient's overall satisfaction, I just don't see it as worth doing in most cases.