pain meds and usage

[johnrsemt]

here our protocols for pain management are very liberal: if they hurt FIX IT.

Pain 3/10 or higher, anywhere, any reason: 100mcg Fentanyl IVP; followed by 50mcg at 5 min. only contra indication is allergy to Fentanyl.

I have a supervisor that gets mad cause I give so much: Private service, lots of older people with injuries or unspecified pain. the supervisor tells me that I give too much; (she gave 2 patients pain meds last year): but if she is ever injured she wants me to treat and transport her.

what are your protocols and thoughts?

 

[Flight-LP]

Drug them till they drool...............

Seriously, pain management is very under emphasized in EMS. Analgesics are available, give them! Nothing chaps my rear worse than seeing a patient in pain and it not being addressed by an EMS crew. We can do better, we need to do better. 3 things to live by in EMS.................

1. Get there fast
2. Be nice
3. Take away their pain

Have a safe day everyone!

 

[MasterIntubator]

If they pass the crap-ometer, ohh yes, pain free all the way!

 

[Ridryder911]

If it is legitimate pain, yes I will treat it very liberally. If it is the old "my back hurts" (chronic), and by the way .. my toe, elbow, etc.. nope, they get a prescrip for 800 Ibuprofen and some other NSAID's...

I realize pain is subjective and I do believe it in treating it as flight described as they drool.. or near apnea...

R/r 911

 

[EMTMandy]

Well, that won't be in my scope of practice for another year and a half or so, but when it is, I will treat obvious pain with drugs FOR SURE. I guess one would feel stronger after they were left in an ER for 8 hours with a shattered knee with NO pain control from anywhere.

 

[bonedog]

Cardiac pain I tx with NTG almost exclusively, as you are also treating the problem. Opiates if they are premorbid to help ease the journey.


Any other legitimate pain I believe it to be our duty to ease or eliminate it.

 

[bonedog]

Oh yes and the attendant is a good judge of pain....

 

[disassociative]

Yes, if the patient is in "Real" pain--of course I will give the appropriate analgesia. However, if they come on my rig telling me, "Well I need 10 mg of this one because 20 mg of that one will not touch it"; I am more weary.

example: "I can't take tylenol 3 or demerol, but morphine works great! or dilaudid works fine!"

Be weary of anyone calling them street terms such as, "K-4's(dilaudid) or OC's(Oxycontin)"; be particularly weary of any pt asking for Oxycontin.

Just remember, before you administer; get that good ole SAMPLE history(specifically allergies and medications) and that initial blood pressure.

 

[EMTMandy]

example: "I can't take tylenol 3 or demerol, but morphine works great! or dilaudid works fine!"

There are some legit patients out there such as these though...I personally have allergies to pretty much every narc. out there. just gotta look at the history and make the call i guess...

 

[disassociative]

I am not talking about allergies. Once you get to the medic level(or even now; if you work on an ALS truck with a medic) or an RN level; you will discover that some of these people; will tell you the exact dose they need of a certain med; having proclaimed no allergies in the SAMPLE history; considering you have asked a relevant question; such as:

"Sir/Ma'am., do you now, or have you ever had an allergy, or adverse reaction to any kind of medicine?"

As Rid says, pain is a subjective thing. That which is a "10" to you might be a "5" to me; or vice-versa. Just as we cannot tell a patient on our ambulance that they are without a doubt suffering from an aortic aneurysm or some other condition requiring definitive/diagnostic scans and tests--we cannot offer a definitive yes or no; as to whether or not the pain is legitimate. Use your judgement and critical thinking skills.

 

[Asclepius]

I tend to not give pain meds a great deal. Mostly, because our calls are in such close proximity to the hospital. A patient has to act like they're in pain to receive pain meds. I love the patients who rate their pain at more than 10, yet there they sit calm, cool, collected...no grimaces, no distress. I am all for being aggressive and making my patients comfortable, but when I am less than five minutes from the hospital and you're not in obvious discomfort...sorry, I'll hold off most every time.

I will say, though, that our system has become more liberal with allowing the field crews to address pain management issues without so much hand holding. We used to have to call for any use of something from the narc box, but now we have standing orders. I credit that to a new younger medical director who got his start in medicine as a paramedic. Still, I think many people in the system are gun shy about getting into the narc box, because of the hand holding we used to have to endure.

 

[MSDeltaFlt]

Cardiac pain, I treat the problem which usually either gets rid of the pain by the time we're backing up, or we're at the ER way before that portion of the protocol is met.

Noncardiac pain - as in, "I tripped and landed on my knee and it's killing me" -with assc'd swelling will definitely get some narcs.

That's just on the ground where it's just me in the back with them. In the air, I've also got a nurse with me and we double team giving them all kinds of stuff.

 

[johnrsemt]

more info

I work PT at a fire dept EMS only; short transport and about the only time I give pain meds are if they are in extreme pain due to fall etc to move them.

I work for a private service FT that we do alot of hospital-hospital transports and ECF to ED; with some fairly long transport times. I treat as I find them.
I have learned that you have to be careful when you don't give pain meds when they say that they are in extreme pain, but the VS are normal: pt on large doses of beta blockers don't have big vs changes.

Transported a 31 y/o last week for emergent surgery for a perforated bowel. The small hospital had given her 10mg Dilaudid in 2hr 30min with almost no relief; pt was moaning and crying. I gave her 100mcg Fentanyl before we left the parking lot, and 50mcg 5 min out from surgical hospital, (35min transport). pt was resting comfortably, with only twinges at larges bumps. VS lower and in better shape.

interesting to see the answers we are getting, thank you for input.

 

[Aileana]

Here, we can only give pain meds for extremity trauma without BHP permission. I'm not certified to give meds, but when I am, if they need it, they'll get it. I'd rather give drugs to seekers than not medicate someone in legit pain.

 

[Asclepius]

Here, we can only give pain meds for extremity trauma without BHP permission. I'm not certified to give meds, but when I am, if they need it, they'll get it. I'd rather give drugs to seekers than not medicate someone in legit pain.

I think it is that mentality that contributes to the abuse of the 911 system. If we don't use our best judgement, they just call us, because we don't know them...they don't know us...surely we'll give them the narcs. Sorry...you have to be in pain to get pain medicine on my truck.

 

[Aileana]

A lot of medics seem to be able to accurately guage whether someone is in legit pain or not. I'm only saying that if there's any question as to whether they're a seeker or not, I'll err on the side of caution. It's a lot harder for fakers here to get pain meds though, since we can only give them (without patching anyways) for extremity trauma. Bit harder to fake a fracture/amputation etc than it is to fake back/abdo etc pain

 

[Asclepius]

A lot of medics seem to be able to accurately guage whether someone is in legit pain or not. I'm only saying that if there's any question as to whether they're a seeker or not, I'll err on the side of caution. It's a lot harder for fakers here to get pain meds though, since we can only give them (without patching anyways) for extremity trauma. Bit harder to fake a fracture/amputation etc than it is to fake back/abdo etc pain

I'm sorry if you felt attacked by my response. I didn't mean to be confrontational or point directly at you. It's just that the abuse of 911 is a real and growing problem everywhere. We're going to all get a great deal better at using our best decision making skills in controlling how liberally we treat some of these people. I also think it is important to err on the side of the patient...but there are a lot of people who you can tell that they're seeking. That's all I'm saying.

 

[Aileana]

^yeah, I definately agree with what you're saying. Guess when you work around people in real pain for long enough, you can tell when someone's in pain or not.
Its always sad to see people abusing the 911 system (acting like we're a taxi service, calling to get meds refilled or for a checkup, drug seeking, etc) but as long as they feel they can get away with it, they'll continue doing it.

 

[Ridryder911]

^yeah, I definately agree with what you're saying. Guess when you work around people in real pain for long enough, you can tell when someone's in pain or not.

Actually that is one of the most common misconceptions. Research and the latest education on pain management has demonstrated that most health care professionals way underestimate the patient's pain response.

Even when you ask many health care professionals many assume unresponsive patients do not feel pain, which is totally incorrect.

Administering or technically prescribing any analgesics should be based upon a thorough history, physical examination. Yes, there are plenty of seekers out there, and yes we realize the B.S. of it all, but even those (abusers) do have pain.

Yes, experience does increase awareness of potential abusers, but again .. really what we administer, the amount is minimal.

R/r 911