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).
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.
I'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 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?
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.