Pain Control

Ok. Now I've well and truly derailed this thread, I have to say, I am shocked that there are 12-week medic programs. Mine was 2 years, M-F 40 hours / week, with 1200 hours on the ambulance and 400 in hospital. And, in my opinion, that was way, way, too short for the things I was able to do as a medic.
 
Brown is not sure if these ondansetron crackers work on cows

You know all this time Brown thought Smash's avatar was of the female reproductive system, poor blind Brown :P
 
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MrBrown said:
You know all this time Brown thought Smash's avatar was of the female reproductive system, poor blind Brown :P
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Now that is heck a funny. ^_^ Now that you mention it, it does... hehe
 
Dammit, now I have to change it!
 
However, how scary is that video? Lights, sirens, "I'm an adrenaline junkie" and crappy intubating technique in the first 30 seconds. Just what we need more of!
 
Smash said:
Dammit, now I have to change it!
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No you don't!

Smash said:
However, how scary is that video? Lights, sirens, "I'm an adrenaline junkie" and crappy intubating technique in the first 30 seconds. Just what we need more of!
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Bro that video is revolting... giant whacker patches, that dude in the black jersey is horribly obese, incorrect terminology, that stretcher looks like its out of the eighties, chest palpation was horrible .... makes Brown want to vomit copiously
 
MrBrown said:
No you don't!



Bro that video is revolting... giant whacker patches, that dude in the black jersey is horribly obese, incorrect terminology, that stretcher looks like its out of the eighties, chest palpation was horrible .... makes Brown want to vomit copiously
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lool I enjoyed the aviator sunnies and french kissing of the mannequins personally
 
the_negro_puppy said:
lool I enjoyed the aviator sunnies and french kissing of the mannequins personally
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Until that fat arsejockey can whip it out and show Brown his commercial pilots license and several thousand hours of jet type experience he is not qualified to wear aviator sunnies.

*Brown goes to look for Brown's aviator sunnies
 
usalsfyre said:
There's a massive cultural bias against pain management in EMS. Providers who appropriately manage pain are seen as "weak" and "gullible". Like Linuss says, there's some who see it as a badge of honor NOT to give out narcotics. You gave to "prove" your pain to these people. There also the folks that will say an ambulance "isn't a damn taxi". The only place I haven't consistently encountered a large percentage of these medics is in CCT.

I've been on the other end. I've experienced a painful injury, and received no pain management from EMS or the ED. This transpired after I was an EMS provider, and had seen the pain management light. It sucks and is providing $hity medical care. If your not managing your patients pain appropriately to the extent allowed under your protocols, guess what, YOU suck as a medic.

What pisses me off about medics in my own service who do this is I was one of the guys jumping up and down screaming in the clinical services office about the homeopathic doses of morphine we used to have written in our protocols. To me, consistent failure to manage pain should be treated the same as any other consistent clinical failure. Remediation, discipline and termination.
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Completely agree. It really makes me angry when medics refuse to treat pain. I have personally been in the ER multiple times for kidney stones and you have no idea how crappy it is to have to "prove" your pain to get some relief. It's ridiculous. I also offer my patients more pain meds just before pulling into the ER. You know they're going to be moved around and poked and prodded again and once they're inside, the rules are a little different regarding medications. Orders must be written and sent to the pharmacy. Procedures have to be followed, codes must be entered correctly, blah blah blah. If I can help my pts by easing their physical pain a little, I will, every single time.
 
paccookie said:
Completely agree. It really makes me angry when medics refuse to treat pain. I have personally been in the ER multiple times for kidney stones and you have no idea how crappy it is to have to "prove" your pain to get some relief. It's ridiculous. I also offer my patients more pain meds just before pulling into the ER. You know they're going to be moved around and poked and prodded again and once they're inside, the rules are a little different regarding medications. Orders must be written and sent to the pharmacy. Procedures have to be followed, codes must be entered correctly, blah blah blah. If I can help my pts by easing their physical pain a little, I will, every single time.
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+1. That is my feeling too.
 
One of the greatest things we can provide is pain control. People call 911 for pain. My chest hurts, my tummy hurts, my leg is cut off and it hurts, OMG that car hit that rebar and impaled the driver...it must hurt, call 911.

Keep it up!! its nice to hear of other "candy man" out there....Hey does anybody have batteries for their "Painometer" ours is out. It Takes a picture of their face and it provides computations how much pain THEY ARE IN.
 
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I'm not only amazed at some providers that refuse to manage pain, but I'm blown away by some of the ridiculously tiny amounts of pain management meds you're allowed to work with before you have to get on the phone and beg for more from a doc.

I'm spoiled. At my primary service, our standing orders allow up to 40mg of Morphine and 500mcg of Fentanyl before calling for additional orders. Now, I'll admit I rarely need to use more than 10 of morphine to control pain, but for trauma with a long transport time, it's nice to know I've got the trust of my MPD and the leeway to effectively manage my patient's pain. If you're not on top of your patient's pain, you're not doing them any favors.

And like Linuss, I like to give a little bump of Morphine or Fent just as we pull into the ED, because I know the PT is going to sit in a room with no pain control for a while. And that ain't no fun.
 
The problem is that a lot of people have flat orders for pain management, rather than weight based. For example a lot of people give morphine in 2-4mg boluses. But for pain control for things like trauma, the dose is .05-1mg/kg. So a trauma patient who is 100kg should be getting 5-10mg per dose. Think about that next time you see someone giving 2 of morphine for a tib/fib fracture on a normal sized male.
 
zmedic said:
The problem is that a lot of people have flat orders for pain management, rather than weight based. For example a lot of people give morphine in 2-4mg boluses. But for pain control for things like trauma, the dose is .05-1mg/kg. So a trauma patient who is 100kg should be getting 5-10mg per dose. Think about that next time you see someone giving 2 of morphine for a tib/fib fracture on a normal sized male.
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Tell Brown nobody actually gives 2mg for some bloke with a nungered tib/fib?

Something like that here, Brown cannot think of anybody who would give less than 5mg of morf, more like 10. They would probably get some ketamine too. Heck we gave the guy with kidney stones 7mg

Good lord!
 
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MrBrown said:
Tell Brown nobody actually gives 2mg for some bloke with a nungered tib/fib?

Something like that here, Brown cannot think of anybody who would give less than 5mg of morf, more like 10. They would probably get some ketamine too. Heck we gave the guy with kidney stones 7mg

Good lord!
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Outdated and ultraconservative protocols Brown, they are rampant.

In the US, pain medications are to be feared along with managing pain.
 
From the land of fried beans and sombreros.

Here morphine is only used inside the hospital. It is a VERY controlled drug, along with other opiates (Thanks Mexican Druglords). So ambulance services are left with almost nothing.

To treat severe pain we got......

wait for it......

Ketorolac 60 mg.

Tell me how awful is that.

Recently we have been using Lysine clonixinate in 200 to 600 mg doses IVP. Its quite effective in moderate to severe pain.
 
My only option is morphine, protocols allow 2x5mg doses before I have to call. I have been begging for Fentanyl and Ketorolac for a while now and our medical director says until people start using what you have why would I give you more?

I hate that so many people under treat pain. I'm sure I've been had by a drug seeker here or there but anyone that actually treats pain has been had. I blame both lazy/uncaring medics and the system for the undertreatment of pain. The control measures on Morphine are the biggest cited reason for not giving it, "She didn't seem that bad and then I have 10 extra pages of paperwork to fill out".
 
marineman said:
"She didn't seem that bad and then I have 10 extra pages of paperwork to fill out".
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[usalsfyre's head explodes]

Yep, that quote is probably 50% of the problem. The other 50% is "He's a drug seeker and I don't want to reward his behavior/make him call more". Makes me want break the medic in question's arm and call him a seeker. As to this quote...
marineman said:
our medical director says until people start using what you have why would I give you more?
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Isn't it his JOB to investigate why morphine isn't being used appropriately, educate/discipline those who aren't practicing good medicine, and change protocols/formulary as needed to ensure best practices?!? Sounds pretty lazy on his part.

[usalsfyre attempts to find all the pieces of his head and put them back together, Humpty Dumpty style]
 
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