Podcast: Narcotics For Pain Control Pre-Hospital

[ResTech]

Prehospital Pharmacology For The Pre-Hospital Provider

By: Jeffrey Guy, M.D.

Title: The use of narcotics for pain control

[LISTEN]

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Jeffrey Guy produces a great Podcast geared towards Pre-hospital providers and is an accompaniment to his textbook, Pre-hospital Pharmacology For The Pre-Hospital Provider. I find his Podcast very helpful and like the way Dr. Guy present's the information.

He offers some good information and review for using pain meds pre-hospital in the Podcast posted above.

Listen and post your thoughts!

 

[ResTech]

I really agree with Dr. Guy that Paramedics... or perhaps their protocols more so... are not aggressive with pain management. And I agree too that with the "universal availability of CT scanning" more pt's. with severe abd pain should be considered for analgesics pre-hospital.

 

[Aidey]

Dr. Guy's podcasts are very good, and if anyone is going to know pain management it will be him.

I agree with him also. One of my biggest issues with pain management pre-hospital is that we are usually given 1 option, most commonly morphine or fentanyl. 1 option vs how many possible pre-hospital analgesics? I'm a firm believer that any ambulance should carry at least 2 different analgesic options, if not 3. I'm personally very partial to Morphine and nitrous, but I do acknowledge that Fentanyl has benefits that Morphine doesn't, I just haven't found it to work as well for orthopedic injuries as Morphine.

Optimally would love to have Fentanyl, Morphine and Nitrous all available, along with either Valium or Versed (which are usually carried for other reasons anyway). Fent to be used in Pts with morphine allergy, pts with the potential for hypovolemia, or for break through pain. Morphine for some orthopedic injuries and for longer transports, and the Nitrous for quick onset pain relief, break through pain, abdominal pain and back pain (types of pain which a lot of protocols say you can't give IV analgesics for pre-hospital).

Versed and Valium are also incredibly helpful in dislocations and burns. Giving a dislocation a skeletal muscle relaxant helps reduce the muscle spasms which are causing 1/2 of the pain. Rather than dumping 200mcg of Fentanyl on them or 15mg of Morphine, you may be able to give 5mg of Valium and then they will only need 100mcg of Fent or 5mg of Morphine to bring the pain to a manageable level.

 

[el Murpharino]

That would require medics to know pharmacology and physiology rather than memorizing a flash card...

 

[Aidey]

I think we're in a Catch 22 with that. If a provider is only given one option, all they need to know is the indications and contradictions for that one option. Requiring a large amount of knowledge, but then not allowing it to be used is one of the things that has allowed the low standards to take over in pre-hospital EMS. People think "well, if we don't get to use it, why learn it?". There needs to be a mutual expansion of both options and knowledge.

That may be a crappy attitude, but I think it's truly how a lot of people feel.

 

[DrankTheKoolaid]

re

Excellent podcast. I'm going to forward this to my Medical Director

 

[downunderwunda]

Optimally would love to have Fentanyl, Morphine and Nitrous all available, along with either Valium or Versed (which are usually carried for other reasons anyway).

Ummm, we do, not Nitrous, we have Methoxyflurane, but we use it as you describe. We also use Morphine in conjunction with Versed (we call it Midazolam here) for limb realignment & difficult extrication & advanced pain relief.

That would require medics to know pharmacology and physiology rather than memorizing a flash card...

Regardless of what drug you are using you should know pharmacology, physiology, pharmacokinetics, pharmacodynamics of the drugs you carry & use.