Pain Control

[mc400]

Excellent post. I agree 100% with pain management and being aggressive with it. I remember being an EMT and treating a guy with multiple but not critical gunshot wounds and the medics on scene were concerned with shock and all kinds of other stuff because the guy was sweaty, rapid HR etc. Flight medic walked up asked him how bad his pain was and gave him 100mcgs of Fent and a couple mg's of a benzo and 2 minutes later told the medic see Pain is a :censored::censored::censored::censored::censored:, makes an patient with otherwise no life threats feel like they are dying. Ever since that day I am an advocate for pain control and anxiety relief. I really like the Idea of a Chest pain protocol including Ativan along with the MONA. Just works so damn good.

 

[8jimi8]

Excellent post. I agree 100% with pain management and being aggressive with it. I remember being an EMT and treating a guy with multiple but not critical gunshot wounds and the medics on scene were concerned with shock and all kinds of other stuff because the guy was sweaty, rapid HR etc. Flight medic walked up asked him how bad his pain was and gave him 100mcgs of Fent and a couple mg's of a benzo and 2 minutes later told the medic see Pain is a :censored::censored::censored::censored::censored:, makes an patient with otherwise no life threats feel like they are dying. Ever since that day I am an advocate for pain control and anxiety relief. I really like the Idea of a Chest pain protocol including Ativan along with the MONA. Just works so damn good.

I wish people would stop quoting MONA. It is not appropriate for all chest pain.

 

[EMTinNEPA]

I would rather be duped by a thousand seekers than not give pain medication to one person who needed it.

 

[rhan101277]

Excellent post. I agree 100% with pain management and being aggressive with it. I remember being an EMT and treating a guy with multiple but not critical gunshot wounds and the medics on scene were concerned with shock and all kinds of other stuff because the guy was sweaty, rapid HR etc. Flight medic walked up asked him how bad his pain was and gave him 100mcgs of Fent and a couple mg's of a benzo and 2 minutes later told the medic see Pain is a :censored::censored::censored::censored::censored:, makes an patient with otherwise no life threats feel like they are dying. Ever since that day I am an advocate for pain control and anxiety relief. I really like the Idea of a Chest pain protocol including Ativan along with the MONA. Just works so damn good.

I would have to consult with med control on this because we only have toradol and morphine. We are getting fent soon and maybe we can do the same.

I would hate to give morphine and be incorrect. If they are in a shocky state you can go ahead and check them on out with some morphine if you are not careful. I am all for pain med. Sometimes I will get the doc on the phone just to cover myself though.

 

[BandageBrigade]

I never truly appreciated how lucky I am to work in the system i do until I started to read this forum. At my service, our pain protocols (read: pain, not agitation or anxiety. Even though they are just as liberal) consists of: morphine, fent, Diluadid, ketorlac, ativan and versed. All on standing orders with no real limits except in special circumstances. I cant remember having to ever call for an order on any type of call.

 

[johnrsemt]

Sorry Linuss; mis read your post the first time around

 

[lightsandsirens5]

Ketamine is indeed the nuts of the duck

Ah ha ha! I have not heard that one! I like that.

 

[Crunch]

man, my system sucks as far as pain management goes. We have to call for orders for ANY pain management. We carry morphine and toradol, but toradols only intended to be used for kidney stones (at 15 mg with online orders). Cardioversion is a standing order, however any sedation to go along with it requires a phone call. There are medics at my service that brag about not breaking the narc box for years.

It goes all the way up the chain here too, the other day we were enroute to an acutely dislocated shoulder, and were canceled off for a BLS unit, which if I'm not mistaken requires supervision approval to send a BLS unit to a trauma. I'm sure it was a painful ride for that gentleman.

We can not medicate for abdominal pain even with online medical control, its really the only protocols of ours that can't be overridden with a phone call to the doc.

The reasoning behind our handcuffs is the idea that since were in urban ems service, were only 10-15 minutes from a hospital 95% of the time. It's frustrating when people, especially those in ems, fail to recognize that there is a difference between "time to the ED" and "time to definitive care" or really any care here. While they may only be in the ambulance for 10 minutes, its not uncommon for a pt to sit on our stretcher in the middle of the ed for 25 or 30 minutes before they even get a bed, let alone see a doc. It gets even worse when you add in the fact that the MDs here are notoriously bad about denying orders to EMS.

 

[HotelCo]

man, my system sucks as far as pain management goes. We have to call for orders for ANY pain management. We carry morphine and toradol, but toradols only intended to be used for kidney stones (at 15 mg with online orders). Cardioversion is a standing order, however any sedation to go along with it requires a phone call. There are medics at my service that brag about not breaking the narc box for years.

It goes all the way up the chain here too, the other day we were enroute to an acutely dislocated shoulder, and were canceled off for a BLS unit, which if I'm not mistaken requires supervision approval to send a BLS unit to a trauma. I'm sure it was a painful ride for that gentleman.

We can not medicate for abdominal pain even with online medical control, its really the only protocols of ours that can't be overridden with a phone call to the doc.

The reasoning behind our handcuffs is the idea that since were in urban ems service, were only 10-15 minutes from a hospital 95% of the time. It's frustrating when people, especially those in ems, fail to recognize that there is a difference between "time to the ED" and "time to definitive care" or really any care here. While they may only be in the ambulance for 10 minutes, its not uncommon for a pt to sit on our stretcher in the middle of the ed for 25 or 30 minutes before they even get a bed, let alone see a doc. It gets even worse when you add in the fact that the MDs here are notoriously bad about denying orders to EMS.

I work in Detroit, and you can get to a level 1 within 10 minutes from anywhere in the city, plus we have 4 more ERs within the city limits, and our protocols aren't that restrictive.

 

[Crunch]

The last orders I got were for 4 of morphine on a 80 kg male with a shoulder injury after being hit on a bike by a car, no other injuries, with a good bp. Pt stated it felt dislocated, no obvious deformity, but noticible muscle spasm. I was denied any benzo.

But, due to all the psych pts we run our acute agitation protocol is standing 5 mg versed and 5 mg haldol with a repeat 5 and 5 if necessary, i might have to try using that one next time.

 

[Veneficus]

The last orders I got were for 4 of morphine on a 80 kg male with a shoulder injury after being hit on a bike by a car, no other injuries, with a good bp. Pt stated it felt dislocated, no obvious deformity, but noticible muscle spasm. I was denied any benzo.

But, due to all the psych pts we run our acute agitation protocol is standing 5 mg versed and 5 mg haldol with a repeat 5 and 5 if necessary, i might have to try using that one next time.

Maybe it is time to find a new medical director?

 

[Melbourne MICA]

Ouch!!!

I'd have to say I'm gobsmacked to read what I'm reading. Pain relief is and has been fundamental to medical practice for thousands of f*##%* years. ANd you have to get medical approval to use 4mg of Morphine for someone with a dislocated shoulder who will probably be well over the 25-30mg mark before he's midazed for the shoulder re-alignment?!!

What's the issue for Gods'sake? And why am I hearing stories about Paras "proud" they haven't opened up the narc box for years. Is there an epidemic of sadism running through the EMS system in the US. Conversely I am delighted to hear others here equally disgusted and that not all the jurisdictions are doing the same thing.

Why is it those running EMS in the US just don't get it. People talk and people find out about all this - and that includes us overseas. We talk about it and our docs and bosses talk about it. The end result is laughter. With all due respect to those doing their best, the enlightened and dedicated, present company included, inevitably you all get tarred with the same brush - and the reputation of your wonderful country suffers as well.

The day my superiors expect me to grovel to give analgesia to ease some poor patients suffering is the day I'll burn my epaulettes and piss on the front lawn of our headquarters.

MM

 

[MrBrown]

\
The day my superiors expect me to grovel to give analgesia to ease some poor patients suffering is the day I'll burn my epaulettes and piss on the front lawn of our headquarters.

MM

Yes but we are trusted, look at even in the days when Frank was teaching MICA Stage 1 at the AOTC it took two years to become a qualified Ambulance Officer and MICA was another year ontop of that.

Even our old Advanced Care Officer qualification too four to five years to obtain.

Look at how closely we work with our physician colleagues; the MAS Medical Standards Committee and our Clinical Management Group know we are competent because the population of Paramedics is much smaller and they have a greater influence upon education than in the US. Victoria only has a handful of Universities that MAS accepts graduates from and a consolidation year ontop of over a thousand hours of University practicum. Here in New Zealand we have two Paramedic Degrees and 1,250 hours of practical clinical exposure during the Degree.

We have a whole gaggle of Clinical Standards Officers and a robust program of continuing education/CCE and Paramedic led research is big. None of this exists in the US, you get your patch and you are left to be with maybe a few classes here and there which teach you nothing new except things like how to manage septic shock with permissive hypotension!

If Brown had spent all that money and time investing in becoming a Consultant Physician and knew that these "Paramedics" could have as little as 12 weeks training Brown would be rather restrictive too!

And yes, its very sad indeed, breaks Browns heart.

 

[Melbourne MICA]

Reds under the bed

You're right Brown but the cynical leftie in me smells profit motive in the US. Not across the board - I won't do a disservice to the many who work their hearts out to set up and run great EMS organisations, provide their EMT's with every opportunity to be great practitioners (rather than technicians) over there but it's hard not to think many of the privates at least are only interested in profits not staff training and education and God forbid - actually providing great service to patients.

MM

Late PS - I wonder if any of the present company think litigation issues are a big driver in decison making in these things, perhaps overly so?

 

[Frozennoodle]

If Brown had spent all that money and time investing in becoming a Consultant Physician and knew that these "Paramedics" could have as little as 12 weeks training Brown would be rather restrictive too!

And yes, its very sad indeed, breaks Browns heart.

Kind of makes me proud that despite being the ***-end of the country, my Paramedic program is 18 months long with 700 hours of clinical and internship required. I can't see how anyone can come out of a 12 week course with any kind of confidence that they aren't killing their patients when we spend an entire semester on pathology and pharmacology.

 

[DrParasite]

Kind of makes me proud that despite being the ***-end of the country, my Paramedic program is 18 months long with 700 hours of clinical and internship required. I can't see how anyone can come out of a 12 week course with any kind of confidence that they aren't killing their patients when we spend an entire semester on pathology and pharmacology.

Just for clarification: was your program 18 months long, 2 nights a week for 4 hours each night (plus 700 hours of clinical time), or was it 18 months long, monday to friday, from 9am to 6pm with an hour lunch, plus 700 hours of clinical time? Just want to see how much time you actually spend in a classroom, instead of how long you were a student for.

 

[Frozennoodle]

Just for clarification: was your program 18 months long, 2 nights a week for 4 hours each night (plus 700 hours of clinical time), or was it 18 months long, monday to friday, from 9am to 6pm with an hour lunch, plus 700 hours of clinical time? Just want to see how much time you actually spend in a classroom, instead of how long you were a student for.

A bit of both. 8:30-4:00 2x a week.

 

[Veneficus]

The day my superiors expect me to grovel to give analgesia to ease some poor patients suffering is the day I'll burn my epaulettes and piss on the front lawn of our headquarters.

MM

You have such a way with words.


I think the major problem is that a large percentage of US providers at all levels are taught in school to fear giving analgesia.

Litigation being secondary.

 

[systemet]

I can't see how anyone can come out of a 12 week course with any kind of confidence that they aren't killing their patients when we spend an entire semester on pathology and pharmacology.

I've got to ask -- are there really 12 week paramedic programs? That's an exaggeration, right? There can't actually be anywhere in 2011 where they teach medic in 3 months?

 

[DrParasite]

I've got to ask -- are there really 12 week paramedic programs? That's an exaggeration, right? There can't actually be anywhere in 2011 where they teach medic in 3 months?

ask and you shall receive: http://tinyurl.com/6z8uyro