Moving a Trauma Patient in severe pain without medications

[RocketMedic]

I'm entirely OK with analgesia for head injuries, provided we are able to manage airways

 

[MSDeltaFlt]

I mean he's been In a rollover into a Deep canyon that has resulted in the fatality of the other passenger. His vital signs didn't trend anything shocky and his ABC's were sufficient, A&Ox2. I'm just calling him critical based on MOI/Location. He's non-ambulatory and Slightly confused, but technically Stable based on vital signs/AVPU

A GCS drop in 2 or more points you can safely assume an ICP of 20 which is critical.

 

[MSDeltaFlt]

I'm entirely OK with analgesia for head injuries, provided we are able to manage airways

Amen

 

[Carlos Danger]

A GCS drop in 2 or more points you can safely assume an ICP of 20 which is critical.

Or a concussion.

 

[VentMonkey]

A GCS drop in 2 or more points you can safely assume an ICP of 20 which is critical.

Heh? Can you cite this with proof, or EBM? I’ve heard of utilizing the AIS scoring system:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3242550/

But, I’m unfamiliar with what I’ve quoted above as safely assuming such a calculation. I’d hate to lead anyone down the wrong path.

 

[MSDeltaFlt]

No. No empirical data. Anecdotal from a critical care course I took saying that would be a safe assumption in the absence of ICP probe during the neuro section.

 

[ParamagicFF]

I consider myself a very empathetic provider. When conditions call for analgesia, I won't hesitate to administer it.
That being said, pain management does fall within a larger system of priorities. What you have described to me reads like a potentially critical patient.
Without immediate access to analgesia, I would begin preparing the pt for transport.

Another poster made a good point in that you shouldn't act on what you expect the subsequent arriving caregivers might do. HEMS could arrive and not agree to give pain meds before moving due to the severity of the injury.

On a positive note you made a call and stood by it. Decisiveness is an important trait in an EMS provider. Make a decision and stick with it up until new information presents itself that calls for reevaluation.

 

[Carlos Danger]

I think the bases have all been covered here already, so my two cents is just that there really is no right or wrong answer. These decisions are highly situational and even fairly subjective. They often depend on details that are hard to convey on an internet forum. If you have the patient's best interest in mind and work through the relevant questions logically (is this a time-critical situation? is giving analgesia going to add significantly to transport time? is it going to worse the clinical condition?), then you'll always come to the right answer, or at least the best one for that specific situation. Pain sucks and we should minimize it whenever possible, but it clearly isn't always the highest priority.

 

[Tigger]

Or a concussion.

Pretty much. In college I worked as a student trainer for a hockey program doing a whole of neuropsych exams. Or concussion tools (SAC score at the time) could show fairly significant changes from baseline and still correlate with very little chance of anything besides a concussion.