Pain management

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Alas

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Hypothetical:

Drive by, pt flags you down, 30-70 yrold states 10/10 sudden onset leg pain, throbbing, constant, non radiating non traumatic. Appears in no distress. Vitals stable, hx irrelevent. Wants to go to hospital, en route says he wants morphine. Same person flags you down everyday for different complain.

What are hypothetical valid scenarios to reasons not to give morphine?

How about pain of unknown etiology?
What if pt was inconsitent with story, therefore slightly confused, a contradiction for morphine?

Any other possible scenarios or reasons?
 
What are his vitals? How do they compare to his normal hr/BP?

What does your gut say?

What is the possible etiology of the pain?

How long is the transport time?

Typically, I need to observe a little bit of distress before I decide to I've narcotics. But I look closely- lines around mouth, sweat on lip/brow, hand position, posture. If they look like they're in pain I will treat them, but all the physiologic signs need to point that way.
 
Also remember that not all pain will cause increases in VS so this isn't as accurate assessment as most think. People with (true) chronic pain can actually have there VS lowered (paradoxical) from acute exacerbation of chronic pain.
 
Depending on the big picture. Could he walk on the leg? Any abnormalities noted? Anything that abc listed? Most likely I would not treat based on what you listed and I would most likely call for a BLS ambulance to transport. Dispatch gets mad when 911 cars go out Of service if they don't have to.

Especially if we transport this person everyday. If this was my first time seeing this person, who am I to judge.

Ie heard this following statement and I believe it to be true...

I would rather give pain meds to 100 seekers than withhold it from 1 person that is truly in pain.
 
Your hypothetical has too many inconsistencies, so, based solely on your hypothetical, no narcs.

Pain 10/10 but no distress and hx irrelevant, and a different complaint every day on top of that? Nah, I don't think so.

And sorry, I disagree totally with the concept of treating 100 improperly so that you don't miss one that really needs help. Those kinds of blanket statements are a poor excuse for providing treatment at any level.
 
Regardless of whether it's a first time transport or the 100th time you are still passing judgement.
 
jwk said:
Your hypothetical has too many inconsistencies, so, based solely on your hypothetical, no narcs.

Pain 10/10 but no distress and hx irrelevant, and a different complaint every day on top of that? Nah, I don't think so.

And sorry, I disagree totally with the concept of treating 100 improperly so that you don't miss one that really needs help. Those kinds of blanket statements are a poor excuse for providing treatment at any level.
Click to expand...

Not necessarily. I mean yes it is a blanket statement. But if someone appears to be in distress, who are you to say they are faking. You have to do a proper assessment and based on clinical findings base your treatment. Not on your opinion of what kind of person it is, and whether or not you think they deserve pain meds. People handle and react to pain differently.
 
Do your findings match the subjective complaint? If not, no pain meds. I could honestly care less what they rate their pain at if the exam findings are inconsistent with the complaint. You have to consider the big picture, especially if the patient has a hx of frequently reporting vague complaints and asking for pain meds. Are we passing judgement? Absolutely! In fact, our protocols are written that way.

"The purpose of this treatment Protocol is to give xxx Paramedics the ability to properly assess and treat patients in pain without having to consult Medical Control prior to administration."

"Caution – Paramedic judgment must always consider safety and efficacy in administration of analgesics."
 
Let me reword the question sorry.

Let's say as a FACT this was a drug seeker. What are some reasons not to give a controlled narcotic to this patient?
 
Alas said:
Let me reword the question sorry.

Let's say as a FACT this was a drug seeker. What are some reasons not to give a controlled narcotic to this patient?
Click to expand...

When it's not indicated.
 
Another thing to remember (no idea if it's relevant in this case) is that some people who deal with chronic pain may complain of (and actually have) 10/10 pain somewhere but are absolutely used to being in pain so they don't show any outward signs of such intense pain. They might "live with" and tolerate 8/10 pain, but bump it up a couple and it's not tolerable anymore but they'll still not have any major outwardly noticeable signs of pain.
 
epipusher said:
Regardless of whether it's a first time transport or the 100th time you are still passing judgement.
Click to expand...

A better term would be "assessing your patient". As others have pointed out, pain is more than just a rating on a pain scale. I have patients barely awake after anesthesia, between snores and their SaO2 at 88, telling me their pain scale is 10/10. Do I believe them? No. Do I automatically give them more narcs? Of course not. I'm not judging them - my assessment tells me that at this point in time, giving narcotics is not in their best interest. That's not cruel or mean - it's reasonable care.
 
Anjel said:
Not necessarily. I mean yes it is a blanket statement. But if someone appears to be in distress, who are you to say they are faking. You have to do a proper assessment and based on clinical findings base your treatment. Not on your opinion of what kind of person it is, and whether or not you think they deserve pain meds. People handle and react to pain differently.
Click to expand...

You are to say, because you are a medical professional that is tasked with deciding whether or not they are faking. Social history, past history of drug or substance abuse, past history of non emergent and vauge complains, and past history of pain scale during those complains is going to be very very accurate about whether this person needs narcotics, before actually looking at the current complaint or vitals or physical assessment.

Your opinion of what kind of person it is (if you are good at assessing people) will be very accurate in telling you whether the complaint is serious at all in many many cases.
 
Just because they are a drug seeker or have a drug history doesn't mean they are immune to pain/are in pain today.
 
This is the reason we should be given choices such as toradol stadol and Nubain
 
There should be a policy in place that specifically addresses the role and responsibilities of paramedics in limiting drug-seeking behavior. The responsibility of providing pain management is clear, so if the countervailing motivation isn't clear then you have very little to draw upon except personal attitudes.
 
I have no problem giving out pain meds wether it's to a seeker or not, however, they still warrent an assessment. I wouldn't just blindly hand over narcs because someone asks for it.
 
terrible one said:
I have no problem giving out pain meds wether it's to a seeker or not, however, they still warrent an assessment. I wouldn't just blindly hand over narcs because someone asks for it.
Click to expand...

This Is what I was trying to get across. I didn't do a very good job. Lol

Just because someone has a history, doesn't mean that you don't assess them TODAY and see what's going and and what's different TODAY. Don't let you're opinion of what kind of person they are cloud your judgement.
 
All I'm advocating is that you do a thorough assessment. A verbal pain scale is just one piece of that puzzle. Patient request is not an indication for medication.
 
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