Paramedic student pain management question

[Clare]

Is the green whistle still in play down there?
http://en.wikipedia.org/wiki/Methoxyflurane

Yes, methoxyflurane is the green whistle. It is carried because not all patients can have entonox and well, you need to have an inhaled analgesic in these circumstances.

It is also useful for the bikes or horses or people on foot who cannot carry a cylinder of entonox or in very, very low workload rural areas.

Most services here have moved away from demerol.

Considering pethidine (demerol) went out of fashion, oh, I don't know ... twenty years ago, I am not surprised!

 

[mct601]

You have to understand, I work in south Mississippi. Many of the services, as well as the state, is behind in many aspects. It may have went out of fashion in NZ twenty years ago, unfortunately it was first line analgesia in some areas just recently here.

 

[Clare]

You have to understand, I work in south Mississippi.

My condolences.

 

[johnrsemt]

Our old protocols where I used to work were great: if it hurt, make it stop. 200mcg max Fentanyl, or 20mg Morphine. Call above that, but with most of the transport times never had issues.
Private service: document why, and your max was what we had, either 500mcg Fentanyl or 50mg but we would do 2-3 hour transports at times.

Abd pain, head pain, dental pain, if it hurts FIX it.

Here, document it and either 200mcg Fentanyl or 20mg Morphine no orders

 

[9D4]

West Valley, Az
• morphine- 2 mg increments to max of 10 mg
• fentanyl- 50-100 mcg, may repeat to max dose of 200

We have a different pain management protocol for burns that allows morphine to be dosed different.
2-10 mg increments, max dose of 20.

 

[DrParasite]

I would really appreciate it if you would include your general area, your current pain management protocol, how effective you think it is and how you would like to see it change!

Statewide, New Jersey doesn't have a pain management protocol (http://www.state.nj.us/health/ems/documents/als_adult_standing_orders.pdf) The state is very behind the times when it comes to treating pain. We didn't administer medications to treat abdominal pain, or possible fractures, or any generic pain. Not my call, that was decided by the state. Some agencies might have individual protocols, but that came direct from the state.

North Carolina's protocols have a much clearer and better defined pain management protocols

If you want to see various states protocols, check out this website http://www.emsprotocols.org/

 

[bflint]

My protocols here in West Michigan allow for pre-radio administration of IV/IO/IM administration of Fentanyl (1 mcg/kg) and Morphine (0.05 mg/kg) in chest pain, traumatic injury, and burns. We can give either dosage for abdominal pain, but it must be post-medical control contact. Our max doses are 200 mcg Fentanyl, and 20 mg of Morphine (which is all we carry anyway).

Sometimes, in the case of a major fracture (Femur comes to mind, with large muscle group involvement), proactive folks will call for orders for Diazepam or Midazlolam for additional sedation.

We have ketamine on the trucks, but their only permitted use right now is as part of our Excited Delirium protocol. However, there has been some rumor of potentially adopting it for use in pain management/sedation sometime in the relatively near future.

I would love to start carrying Dilaudid, but I doubt that will be happening anytime soon!

 

[systemet]

We have ketamine on the trucks, but their only permitted use right now is as part of our Excited Delirium protocol. However, there has been some rumor of potentially adopting it for use in pain management/sedation sometime in the relatively near future.

It's a great adjunct, either as a lower dose to augment opiates (e.g. 0.2mg/kg), or a dissociative dose (~ 0.5 mg/kg) for procedural sedation. I treated a kid with a mid-shaft femur fracture last year, 100ug fentanyl, 30 mg ketamine, he didn't make a sound as we realigned and traction splinted his leg. Despite a fairly bumpy transport, he tolerated the pain well. His largest expression of discomfort was a sigh as we moved him off the scoop at the ER. Made me a believer.

 

[Sunburn]

We work similar to NZ here.
For mild pain oral ibuprofen or IM diclofenac.
For moderate pain diclofenac IV, tramadol orally or IV
For severe pain morphine and sedation (we only carry diazepam and haldol).
Since EMS teams here include MDs we don't really have upper limits, we can go as high as needed and safe considering max dosage of drugs. I once had an instructor tell me "why do people fear morphine? Worst that can happen is respiratory distress, and you all carry trach kits, SG airways and respirators in your vans"