Pain free stick and shots

[skyemt]

without mentioning names, the nature of the disagreements is obvious...

Rid and others talk about what is best for the patient, and others, well, you seem to talk about what's best for you...

i continue to be surprised that so many think this job is about them.. it is all about the patient... and whatever makes the patient feel better, even for ten minutes,is good patient care.

maybe i am naive, but come on folks...

 

[Hastings]

without mentioning names, the nature of the disagreements is obvious...

Rid and others talk about what is best for the patient, and others, well, you seem to talk about what's best for you...

i continue to be surprised that so many think this job is about them.. it is all about the patient... and whatever makes the patient feel better, even for ten minutes,is good patient care.

maybe i am naive, but come on folks...

It's unfair that I'm being portrayed in this pain-is-great way, because I strongly believe in pain relief when appropriate. I believe that patients should be made as comfortable as possible. Morphine before moving the old lady with a hip fracture and all. But come on, it's an IV. And more importantly, it's a procedure that often times is done "just because." And I believe that the steps I listed in my previous post is providing the most consideration to the patient in the situation. Especially when, as stated, we don't even have any drugs like Rid is referring to. And I'm certainly not going to be giving any narcotics for an IV start.

So at the basic level, I don't have drugs to numb an area before an IV start.

At the next level, I believe explaining why they need an IV, giving them the option to refuse, not attempting more than once, and not starting one if not absolutely necessary provides the best patient care to my patients.

 

[triemal04]

I'm a big fan of Nitrous too. Unfortunately, very few EMS providers carry it.

Anyone that is bad enough to NEED an IV in the short period of time between the scene and the hospital that fights against it is not in their right mind. And in such a case, you find a way to do it through the fighting. Anyone else can wait until the hospital. And trust me, the hospitals around here wont give them anything for needle pain either. Mostly because the anxiety of getting a shot/IV is often not due to the pain at all.

But even beyond that, why won't I numb someone up for an IV? Besides time, that is? Because we don't carry anything that can.

Unfortunately, even many people who "need" an IV will not just sit there and allow you to start it, as I've said before. And no, doing it "through the fighting" isn't always the best choice; if the issue is due to anxiety, nitrous is great, if it is due to pain (when they rip their arm away from you as soon as you penetrate the skin) you use a numbing agent. (many people we pick up are also not in their right mind...go figure) Sometimes "doping up your patients" is the best course of action, the only course sometimes. Physically restraining someone to start an IV if you have other more appropriate options...not a good idea. Remember, this job is not about what is easiest for you, but what is best for you patient.

As well, forget time...although there are exceptions to this, if the appropriate course of treatement means that you have to sit on scene for another minute, or your call lasts just a bit longer...do it. Again, what is best for the patient is what we should be concerned with.

Good patient care includes not starting an IV just-because, telling the patient that you want to give them and IV and why, giving them an opportunity to refuse, and letting someone else try if you can't get it the first time.

You do know that none of that matters, right? If the patient loses it when you try and start a line, why would it be any different when the next person does? And explaining a procedure, while damned important, won't fix that problem either.

At the next level, I believe explaining why they need an IV, giving them the option to refuse, not attempting more than once, and not starting one if not absolutely necessary provides the best patient care to my patients.

Again, explanations are great, but don't expect them to always work; you need to have a plan for when, either because of anxiety/needle phobia, pain, or some other reason, the patient will not allow you to start an IV.

Saying that you don't do this because it's not an option is a lot different than saying that it's innapropriate.

 

[Hastings]

Again, explanations are great, but don't expect them to always work; you need to have a plan for when, either because of anxiety/needle phobia, pain, or some other reason, the patient will not allow you to start an IV.

Any patient that does not have an altered LOC has a right at all times to refuse treatment. That includes an IV. If, after I have explained why I want to start an IV, they say no, then I - as I legally and morally should - respect their wishes and do not start one.

That is my plan when a patient refuses treatment.

 

[triemal04]

Any patient that does not have an altered LOC has a right at all times to refuse treatment. That includes an IV. If, after I have explained why I want to start an IV, they say no, then I - as I legally and morally should - respect their wishes and do not start one.

That is my plan when a patient refuses treatment.

Anyone that is bad enough to NEED an IV in the short period of time between the scene and the hospital that fights against it is not in their right mind.

Completely understood. If they aren't altered then they can refuse. But if they really need one and aren't altered and still refuse, then they really are altered, so you'll just go back to having to...what? Restrain them? Not start it? What?

There is a need for topical anesthetics or analgesics prior to starting an IV pre-hospital. Just because you have not been able to use them, did not realize how they could have been used, or are not willing to admit that these things have a role in the field does not change that need.

 

[Hastings]

Even if a patient needs IV intervention to save their life, they still have the right to refuse if they don't have an altered level of consciousness. I'll explain the risks over and over again, and my reason for needing to start an IV, but in the end, if they refuse for ANY reason, then I cannot start that IV. If a patient is so scared that they'd rather die than get an IV, then the fear goes far beyond a simple dislike of pain, and it's not a fear that can be worked around with numbing agents. Most fear of IVs isn't pain based.

 

[Ridryder911]

Like I described, 95% or more of the time I never use analgesics for an IV. I do though like to have an option. It is not hard to obtain. Do like I did and write a protocol and then purchase it, just like any other medication. Most Doc's are very understanding and usually assume you have it.

Ethyl Chloride is about $26 a bottle that will usually last a year or more, if the medics does not play or waste it. Lidocaine 1% is real cheap in multi-dose vials, usually the ER may even give you some discount or even give you a small multi-dose vial. Again, just an option for your patient.

I ask do you not place viscous Lidocaine for gastric tubes or nasal intubations as well? Remember studies and now even successful litigation's against health care providers for not providing pain control. Many are ignorant at the fact that unresponsive patients have pain as well. Be forewarned if you mark grimacing as r/t fracture, chest pain and do not treat the pain (when it could be treated) you may be held accountable.

Treating pain has been one of the forefront of things to change in medicine. If the patient (truly) hurts treat it, that is really what you are there for. Again, the justification should be why not; instead of why?

R/r 911

 

[Hastings]

Like I described, 95% or more of the time I never use analgesics for an IV. I do though like to have an option. It is not hard to obtain. Do like I did and write a protocol and then purchase it, just like any other medication. Most Doc's are very understanding and usually assume you have it.

Ethyl Chloride is about $26 a bottle that will usually last a year or more, if the medics does not play or waste it. Lidocaine 1% is real cheap in multi-dose vials, usually the ER may even give you some discount or even give you a small multi-dose vial. Again, just an option for your patient.

I ask do you not place viscous Lidocaine for gastric tubes or nasal intubations as well? Remember studies and now even successful litigation's against health care providers for not providing pain control. Many are ignorant at the fact that unresponsive patients have pain as well. Be forewarned if you mark grimacing as r/t fracture, chest pain and do not treat the pain (when it could be treated) you may be held accountable.

Treating pain has been one of the forefront of things to change in medicine. If the patient (truly) hurts treat it, that is really what you are there for. Again, the justification should be why not; instead of why?

R/r 911

Write a protocol and then buy the drug? I'm not sure what awesome fantasy world you're living in, but things don't work that way around here. The drugs we're allowed to carry and the protocols related to them are created by the medical director and whoever else, and only they have the ability to change them. And trust me, they're not getting changed.

 

[skyemt]

is this really that different from someone wanting to refuse treatment? if you think they really need to go, and they are not AMS and want to refuse, do you actually say, "well, ok, they are allowed... not gonna force ya... bye"...


COME ON.... you know there is more to it than just giving an explanation...
there is compassion, and understanding the patients fears and needs, and relating to them on their level, not trying to get them to relate to YOU on YOURS.. see the pattern here???

i have seen many patients who wanted to refuse both treatment and IV's talked into it, not just because they were given "explanations", but because the EMT's and Medics related to them on their level.

not sure you are seeing the big picture here...

 

[Ridryder911]

Write a protocol and then buy the drug? I'm not sure what awesome fantasy world you're living in, but things don't work that way around here. The drugs we're allowed to carry and the protocols related to them are created by the medical director and whoever else, and only they have the ability to change them. And trust me, they're not getting changed.

Sorry, I will never work in such a system that medical control does not work and participate with the medics. Yes, I write the protocols (as well as a committee) and then the physician reviews and alters them as he/she seems fit. Otherwise protocols become stagnant overtime and should be reviewed yearly as needed for change. Emergency medicine changes to often to have orders stay the same.

R/r 911

 

[skyemt]

Sorry, I will never work in such a system that medical control does not work and participate with the medics. Yes, I write the protocols (as well as a committee) and then the physician reviews and alters them as he/she seems fit. Otherwise protocols become stagnant overtime and should be reviewed yearly as needed for change. Emergency medicine changes to often to have orders stay the same.

R/r 911

We just had a meeting with head of our ER and member of the local REMAC...
met with agencies in the area, which he does periodically, to ask for input into new protocols to be written.. they are always changing, and they value the EMT and Medic input to make these changes... at JEMS conference, had a conference with Medical Directors from many states, who do the same...

i'm not really sure why so many seem it is something done behind closed doors and only at the whim of the Medical Director? I suppose it many be that way in some states, but clearly it is not the norm.

 

[Hastings]

Sorry, I will never work in such a system that medical control does not work and participate with the medics. Yes, I write the protocols (as well as a committee) and then the physician reviews and alters them as he/she seems fit. Otherwise protocols become stagnant overtime and should be reviewed yearly as needed for change. Emergency medicine changes to often to have orders stay the same.

R/r 911

Sounds like a great, progressive system. Just one we don't have.

is this really that different from someone wanting to refuse treatment? if you think they really need to go, and they are not AMS and want to refuse, do you actually say, "well, ok, they are allowed... not gonna force ya... bye"...


COME ON.... you know there is more to it than just giving an explanation...
there is compassion, and understanding the patients fears and needs, and relating to them on their level, not trying to get them to relate to YOU on YOURS.. see the pattern here???

i have seen many patients who wanted to refuse both treatment and IV's talked into it, not just because they were given "explanations", but because the EMT's and Medics related to them on their level.

not sure you are seeing the big picture here...

The compassion and empathy come in when I explain why I want to start an IV, and the risk, etc, etc. I relate to them while explaining everything. The point is that if they can't be talked into it after I've done my best, I'm not going to push it.

 

[Flight-LP]

Sounds like a great, progressive system. Just one we don't have.



The compassion and empathy come in when I explain why I want to start an IV, and the risk, etc, etc. I relate to them while explaining everything. The point is that if they can't be talked into it after I've done my best, I'm not going to push it.

Personally, I think this is a deeper issue for you than you describe based in your postings, however I rarely ever have a patient remotely question, much less refuse an IV. Without re-hashing all of the other logical responses, I too agree with their postings. Any available resource to ease a patient's anxiety or pain tolerance should be employed. Your "one stick" idea is great and all, but what happens when you are the only ALS provider available? Sorry, but again your logic falls short........................

 

[mikeylikesit]

Hastings, like you stated you only have a few minute transport time for patients so you have the luxury to wait for IV starts. Most however can't allow 30+ minutes for a dehydrated patient to refuse fluids. i like anesthetics because i have them and i know that i will never ever have a patient refuse an IV if i can promise them that it wont hurt. It then becomes as much of a decision for the patient as "can i check your pulse?"

 

[Hastings]

Hastings, like you stated you only have a few minute transport time for patients so you have the luxury to wait for IV starts. Most however can't allow 30+ minutes for a dehydrated patient to refuse fluids. i like anesthetics because i have them and i know that i will never ever have a patient refuse an IV if i can promise them that it wont hurt. It then becomes as much of a decision for the patient as "can i check your pulse?"

And that's all well and good. That's probably why some have the ability to numb while I don't. Because it is recognized here that it is not necessary. And that is it, right there. Short transport times.

 

[MasterIntubator]

There is a product called "shotblocker" which has been used for years and years and is based on pain diversion. Works very well. There is also a 'U' shaped version for IV's that I have used.

Holistic, kids love it. Tried it many times on myself with folks giving me IM saline shots.... it is quite fascinating

 

[So. IL Medic]

So laying someone out for starting an IV was hyperbole?

 

[So. IL Medic]

Like I described, 95% or more of the time I never use analgesics for an IV. I do though like to have an option.

R/r 911

Now that makes more sense.

 

[So. IL Medic]

Write a protocol and then buy the drug? I'm not sure what awesome fantasy world you're living in, but things don't work that way around here. The drugs we're allowed to carry and the protocols related to them are created by the medical director and whoever else, and only they have the ability to change them. And trust me, they're not getting changed.

Hastings, something to ask your med director and ems coordinator about:

Our system has a simple committee comprising of one medic from each service in the system, the EMS coordinator, and the Med Director sits in as time permits. We meet every four months. Primary purpose is protocol review, secondary is any other system issues, such as a continuing education schedule was set in the last meeting. Our Med Director was actually very pleased for the opportunity for two-way feedback when the committee was formed - at the request of the medics no less.

It's worth a shot to do something similar.

 

[triemal04]

Better late than never.

Hastings, you seem to have the attitude that, just because your service doesn't carry it, it's not neccasary. As well, that because you have short transport times proper patient care isn't neccasary. This is a horrible stance to take, and will only cause you grief in the future. Not to mention (this may be wrong, if it is then ignore it, or just consider it a blanket statement for anyone new to the field) that some of your posts seem to indicate that you are new, like maybe a year new, to the field. If this is the case then your attitude is doubly bad; now is when you should be rounding out what you learned in school and learning all the things that you didn't pick up. This is the time when you should be learning all you can, not getting dead-set in your ways.

Medicine changes, almost on a daily basis. And many services will carry equipment or do things that yours does not. To discount these things because you don't do them, or don't think they are neccasary is setting yourself up for failure, both as a paramedic, and as a person.