Pain management

[PFDEMT]

This is silly..
all our reading into the situation way to much..
we do NOT have to give px meds. we are required to treat based on WHAT we see.. I say pt goes bls then the docs decided to give px meds.

If your taking him to the hospital every day then he should have a full house of px meds. Odds our he needs a ride to down and needs a fix..

 

[epipusher]

This is silly..
all our reading into the situation way to much..
we do NOT have to give px meds. we are required to treat based on WHAT we see.. I say pt goes bls then the docs decided to give px meds.

If your taking him to the hospital every day then he should have a full house of px meds. Odds our he needs a ride to down and needs a fix..

I ferl sorry for ALL of your patients.

 

[PFDEMT]

Havnt had a complaint yet.

They post states a guy 30-70 y/o

1-- if a guy that is 30 looks 70 odds are drugs aged him
2---a guy is flagging you down not calling 911 day after day..

3--- its a different complaint everytime..

I just know what the post gave me and screams
frequent flyer for drugs and ride...
if its truley an emergency he wouldnt be out side flagging down ems.

 

[PFDEMT]

I ferl sorry for ALL of your patients.

Havnt had a complaint yet.:censored:

They post states a guy 30-70 y/o:censored:

1-- if a guy that is 30 looks 70 odds are drugs aged him:censored:

2---a guy is flagging you down not calling 911 day after day..:censored:

3--- its a different complaint everytime..:censored:I just know what the post gave me and screamsfrequent flyer for drugs and ride...:censored:if its truley an emergency he wouldnt be out side flagging down ems

 

[Christopher]

It is seriously pretty simple:

"Ma'am/sir, you've told me your pain is X out of 10. Would you like me to give you anything for the pain? Are you allergic to <insert medication appropriate to clinically correlated pain assessment and scale>?"

Was that so hard?

Then in <insert rebolus interval here>:

"Ma'am/sir, now that we've given it some time, what is your pain level now?....Ok, would you like anything more for the pain?"

Done and done! It is almost like we're treating patients 'n stuff.

 

[triemal04]

I ferl sorry for ALL of your patients.

And I feel sorry for all of your patients since you apparently aren't capable of assessing a patient and then creating a treatement plan based on your findings.

If all you do, or are capable of doing is blindly giving medications or performing procedures because someone tell's you something and ignoring the rest of your clinical findings and whatever medical education and knowledge you have then you should never be in the position to independently practice medicine.

I don't know why people are so fanatical about this, other than a lack of education. It's very simple, and no different than determining the correct treatement for a complaint of shortness of breath. You assess your patient and determine if a treatement is needed, and if so, what the appropriate treatement is. You do not blindly give out ANY medication without assessing the patient first.

End of story.

 

[PFDEMT]

and i feel sorry for all of your patients since you apparently aren't capable of assessing a patient and then creating a treatement plan based on your findings.

If all you do, or are capable of doing is blindly giving medications or performing procedures because someone tell's you something and ignoring the rest of your clinical findings and whatever medical education and knowledge you have then you should never be in the position to independently practice medicine.

I don't know why people are so fanatical about this, other than a lack of education. It's very simple, and no different than determining the correct treatement for a complaint of shortness of breath. You assess your patient and determine if a treatement is needed, and if so, what the appropriate treatement is. You do not blindly give out any medication without assessing the patient first.

End of story.

booooooommm!!!!

 

[Carlos Danger]

This is the reason we should be given choices such as toradol stadol and Nubain

Stadol and Nubain are both opioids, too.

And they can be dangerous to give to opioid addicts.

 

[epipusher]

booooooommm!!!!

My assumptions about your attitudes towards patients on and off this forum are probably not far off.

 

[usalsfyre]

And I feel sorry for all of your patients since you apparently aren't capable of assessing a patient and then creating a treatement plan based on your findings.

If all you do, or are capable of doing is blindly giving medications or performing procedures because someone tell's you something and ignoring the rest of your clinical findings and whatever medical education and knowledge you have then you should never be in the position to independently practice medicine.

I don't know why people are so fanatical about this, other than a lack of education. It's very simple, and no different than determining the correct treatement for a complaint of shortness of breath. You assess your patient and determine if a treatement is needed, and if so, what the appropriate treatement is. You do not blindly give out ANY medication without assessing the patient first.

End of story.

Why do I feel so strongly about this? Probably because I've seen "paramedics" (using the term extremely loosely) withhold pain meds from legitimate pathology far more than I've seen them make reasoned assessments, or give it inappropriately, especially if the patient in question doesn't meet the providers description of worthy of their care. EMS providers tend to be a judgmental bunch, and assessments and treatments often seem tailored to that provider's personal biases. Further, few paramedics actually delve into chronic pain, ect, and when they do it's an excuse to WITHHOLD meds rather than administer.

In short, you're right, many paramedics are incapable of using assessments to for a clear clinical picture and treatment plan, but in exactly the opposite way you think.

 

[NomadicMedic]

Okay folks. Everyone take a deep breath or this thread gets my full, undivided attention.

 

[PFDEMT]

My assumptions about your attitudes towards patients on and off this forum are probably not far off.

You must be one of those medics that think you can save the world..

 

[triemal04]

Why do I feel so strongly about this? Probably because I've seen "paramedics" (using the term extremely loosely) withhold pain meds from legitimate pathology far more than I've seen them make reasoned assessments, or give it inappropriately, especially if the patient in question doesn't meet the providers description of worthy of their care. EMS providers tend to be a judgmental bunch, and assessments and treatments often seem tailored to that provider's personal biases. Further, few paramedics actually delve into chronic pain, ect, and when they do it's an excuse to WITHHOLD meds rather than administer.

In short, you're right, many paramedics are incapable of using assessments to for a clear clinical picture and treatment plan, but in exactly the opposite way you think.

Then you work with far to many incompetant paramedics, and instead of insisting on a change to proper treatement you want that incompetance to be perpetuated and even extended to others who might be capable of appropriate decision making. You want people to think that it is appropriate and right to treat patients without first knowing what treatement, if any, is actually needed. In the many, many threads about this the common refrain is always "if the patient says they are in pain then I give them narcotics." No mention of actually assessing their patient to determine what is, or isn't needed. No mention of taking in the overall clinical context. This is so far from proper care it is unbelievable, and to see people advocate this and think that it is in any way, shape or form appropriate is disgusting.

Your job is to assess, and appropriately treat your patient. It does not matter what their complaint is, be it shortness of breath, a cough, pain, or something else. If you, or anyone else thinks that it is appropriate to blatantly give out any type of medication or treatement without first determining if it is needed then you belong in a different field.

***for the sake of keeping the thread open it should be noted that the "you" I'm referring to is an ambiguous one.***

 

[Brandon O]

Your job is to assess, and appropriately treat your patient. It does not matter what their complaint is, be it shortness of breath, a cough, pain, or something else. If you, or anyone else thinks that it is appropriate to blatantly give out any type of medication or treatement without first determining if it is needed then you belong in a different field.

This is undoubtedly true. What sort of assessment findings do you have in mind to inform this decision?

 

[Ewok Jerky]

The International Association For the Study if Pain defines "pain" as:

Unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.


Pain is an experience. Its not something easily quantified objectively. If your Pt tells you they are in pain, then we must assume that they are, in fact, in pain.

 

[triemal04]

Ok. Let's look at a couple of things for acute issues.

Looking at physical signs is a start, but should NOT be the single deciding factor. While severe pain will usually activate the bodies stress responce to some degree (elevated heartrate and BP) it may not happen all the time, or be that pronounced. And potentially you may see a drop in the pulse if the patient is bearing down (transiently or not), which would also be worth noting. Are they sweating? Like everything here, it may or may not be present and this shouldn't be the deciding factor.

How is the patient holding themselves? Does it fit with the reported location of pain and the cause (if there is one)? Someone with a musculoskeletal injury will generally not be moving the affected part or making sudden movements with their body. Example; severe back pain is generally when you will see someone laying very, very still and limiting any movement of any body part. Rib injuries are similar; though not directly connected to the affected area, almost any movement hurts. Curling up with some writhing with a vague complaint of abdomenal pain is different than doing the same while complaining of lower back pain.

Does your physical exam fit with the location and cause? Lightly brushing your hand across a flat, non-distended abdomen shouldn't elicit a responce; actual palpation may. For the abdomen, is the patient consistently gaurding? If so does gentle palpation cause a reaction, or deeper? Is your exam consistent? If you come back to the same area with the same technique, is the responce the same? If this was a traumatic injury or there any outward signs of injury? Are they distractable during your physical; does firmly palpating a non-injured/painful area while gently palpating the reported part cause a responce?

Does the history fit with the complaint? If this was an acute traumatic injury, is the reported event consistent with the reported injury? Has there been a change in the pain?

Is the patient's story constant? Does varying the format of your questions bring up a different responce? Do their responces change if you ask several questions that are unrelated to the current issue before continueing with the history?

Are they distractable during the history? Can you change the topic to something other than their complaint of pain and remain on it? Does their demeanor change during this?

That should be enough to get you started. Obviously the examples given aren't meant to be a comprehensive list (I wish I didn't actually have to say that) but are just a few examples of the different things you should be looking at.

This is of course leaving out the "classic" signs of drug-seeking behavior, which, like the above, shouldn't be looked at by themselves but taken in as a whole.

Obviously all these things can be faked with effort, and in some patient's you won't be able to know for certain; pain is unfortunately a very subjective finding without outward signs that are "always" there. At that point it is appropriate to err on the side of treating your patient.

But that is only after you have done your job.

 

[Paramedic0311]

Unless this patient is unable to comprehend reasoning, you need to have a conversation with them on all of the really sick people who have emergencies who's life he/she is putting in danger by dedicating emergency resources no non-emergency habitual calls. If you keep giving narcs they will keep calling.

If an assessment indicates along with sound judgement, let em have it.

 

[FiremanMike]

It would be virtually impossible to do without turning this into a :censored: swinging contest, but it would be interesting to find out the department run volume and district demographics of the various posters on this thread and to see if there's a correlation between that and their opinion on this scenario.

 

[usalsfyre]

Unless this patient is unable to comprehend reasoning, you need to have a conversation with them on all of the really sick people who have emergencies who's life he/she is putting in danger by dedicating emergency resources no non-emergency habitual calls. If you keep giving narcs they will keep calling.

If an assessment indicates along with sound judgement, let em have it.

Your moral obligation is to the current patient, not any potential future patients.

 

[usalsfyre]

It would be virtually impossible to do without turning this into a :censored: swinging contest, but it would be interesting to find out the department run volume and district demographics of the various posters on this thread and to see if there's a correlation between that and their opinion on this scenario.

I've run just about every system size, volume and demographic out there and it hasn't changed my thought process. This tends to go back to my prior statement that pain management in EMS often seems to be demographically driven rather than patient driven.