Patient with distracting injuries

[Melclin]

I don't really know why you'd even bother thinking about collar or boards in this pt. He self extricated, drove to you and walked to the ambulance. What on earth is a collar and board going to provide that laying reasonably still won't.

 

[dstevens58]

There are a lot of things you would wish to do, but with a completely oriented and alert and under no compromising chemical influence......

document both the offer of treatment and their refusal and let it go with that. Don't focus on what you want to do, focus on what the patient will allow you to do for them.

 

[EMS Patient Care Advocate]

awesome information and to see different pain managment protocols. Ohhh yea ketamine would have been his godsend. Im enjoying the thread hope its getting better for you too.

 

[Handsome Robb]

I just double checked our meds list out here and nitronox, fentanyl, ketamine... all still not on the list.

We don't have ketamine here either and a little bird just told me they took nitronox away. Not sure if that is just from Intermediates or completely gone. Gonna grab a new book tomorrow and find out.

For medics they can do analgesia and sedation for "Pain in association with large muscle mass (such as femur) fracture or severe back pain" Pt must have a GCS of 13 or better and be hemodynamically stable, SBP >90.

As long as proper documentation accompanied this with burns, I don't see why it would be inappropriate. Same analgesic dose along with 2-5 mg midazolam aiming for pain <5/10 and a Bloomsbury score of 0-1.

The other option we have for burn patients is if they are outside 'the loop' geographically and meet criteria for a burn center
"1. Partial-thickness burns of greater than 10% of the total body surface area
2. Burns that involve the face, hands, feet, genitalia, perineum, or major joints
3. Third-degree burns in any age group
4. Electrical burns, including lightning injury
5. Chemical burns
6. Inhalation injury
7. Burn injury in patients with preexisting medical disorders that could complicate management, prolong recovery, or affect mortality
8. Burn injury in patients who will require special social, emotional, or rehabilitative intervention"

We can request HEMS transport to UC Davis Burn Unit. They will either meet us enroute or we will go directly from the ambulance to the aircraft at the hospital and bypass the ED. They have RSI and other sedation options.

 

[jjesusfreak01]

Our max narcotic dose is doubled for pain management in burn patients, and a quick call to the medical director will raise that to whatever level the medic deems appropriate.

 

[usalsfyre]

The last real burn pt I had required 200mcgs of fent nasally before I could get him to sit still enough to even move the cot or get a BP. He was an MVC also. Any attempt to board him would have been more injurious than putting him in a position of "comfort".

 

[Slinky]

Just chase it with diphenhydramine. Most of the hypotension associated with morphine is due to the associated histamine release. Diphenhydramine is an effective way to minimize the risk of it. Besides, you'll be obtaining vascular access so any hypotension is easily corrected.

I believe that the morphine induced hypotension due to histamine release is seen predominately at high levels of morphine administration (studies done at 1 mg/kg during anesthesia). Isn't most morphine induced hypotension at the EMS street level due to other factors, such as hypovolemia? I don't think 5-20 mg of morphine causes much hypotension due to a histamine release.