Should I85s be allowed to help with pain managment?

[DrParasite]

a civilian can give over the counter pain meds, why can't an trained medical provider (EMT, I-85 etc)?

 

[usalsfyre]

Intermediates can give nitronox. Well at least here they can :unsure:

As mentioned in another thread, good luck finding a blender .

IN fentanyl is safe, mostly effective and aside from controlled substance concerns, easy to use.

 

[EMT91]

The answers you seek can be found here:


http://www.amazon.com/Guyton-Hall-T...2&sr=8-1&keywords=Guyton's+medical+physiology

and here:

http://www.amazon.com/Robbins-Cotra...=1-1&keywords=Robins+and+Coltran+Pathological

Nice. I ask however that you explain to me the particular topic under discussion as an experianced medic to a newbie, please.

 

[TransportJockey]

EMT-Is in NM can administer IV Fentanyl and Morphine w/ MCEP orders. Did it quite often as an EMT-I running an ILS 911 transport truck.

 

[Melclin]

Nice. I ask however that you explain to me the particular topic under discussion as an experianced medic to a newbie, please.

Not to answer for Vene, but from my point of view the problem from the start is that these things have been explained in single sentences or paragraphs.

Its more complicated than that.

Thats why I gave links in my PM and not answers. I myself couldn't do the topic justice. IMHO the description of the clotting cascade in guytons is brilliant because it describes things in more detail than any other general text I've read but does it in a way that is both enjoyable and easy to understand for just about anyone. I read several other books and I didn't really get it. When I read guytons, I actually got it. PM me and we can probably sort out a copy if you're genuinely interested.

 

[Doczilla]

I'm confused, are you asking for a physio lesson on how asprin works? In the time it takes to demand a response, you could easily look it up, then discuss your findings with us.

The best providers are self-improving and self motivating.

 

[STXmedic]

The best providers are self-improving and self motivating.

Quoted for emphasis.

Getting spoon-fed tidbits will not serve you nearly as well as you researching it yourself.

 

[Veneficus]

Nice. I ask however that you explain to me the particular topic under discussion as an experianced medic to a newbie, please.

I will address this by PM.

 

[EpiEMS]

EMT-Is in NM can administer IV Fentanyl and Morphine w/ MCEP orders. Did it quite often as an EMT-I running an ILS 911 transport truck.

Were these already in place on a pump or something of the sort? Or were you guys pushing them?

Just thinking out loud here: if nitrous oxide is part of the national scope of practice for the AEMT, then there must be several places that use it, no?

 

[VFlutter]

You also have to remember that the cardiac dose (160-325mg) is lower than the typical dose given for analgesia (325-650mg).


Here are the two books I use on a regular basis. If you buy them new you get the Ebook along with it that you can put on your iPhone which is awesome for clinicals.

http://http://www.amazon.com/Mosbys-2012-Nursing-Reference-Skidmore/dp/0323069177

http://http://www.amazon.com/Mosbys-2012-Nursing-Reference-Skidmore/dp/0323069177

Great book for the price, easy to read and understand but is not as advanced as some others.

 

[TransportJockey]

Were these already in place on a pump or something of the sort? Or were you guys pushing them?

Just thinking out loud here: if nitrous oxide is part of the national scope of practice for the AEMT, then there must be several places that use it, no?

Nope, pull tjem out of the safe, call for orders, and draw and push the narcs

 

[Handsome Robb]

As mentioned in another thread, good luck finding a blender .

IN fentanyl is safe, mostly effective and aside from controlled substance concerns, easy to use.

True.

We have lots of them but if the VSTs don't like the way you are handling it you'll get screeched at for reasons you pointed out in that thread.

Agreed about fentanyl, it would be a good option at the ILS level if there wouldn't be an uprising about it.

 

[EpiEMS]

Nope, pull tjem out of the safe, call for orders, and draw and push the narcs

Didn't realize that EMT-Is could give narcs. Thought it was medic-only. Interesting!

 

[VirginiaEMT]

I think this demonstrates wy intermediates are not permitted to administer it.

It is unfortunate that prehospital pain management in the US has to be a narcotic or nothing most of the time.

You are referring to I-85s aren't you. As a I-99 I have Morphine and Fentanyl in my box as standing order drugs. Is this not the case most places?

 

[EpiEMS]

You are referring to I-85s aren't you. As a I-99 I have Morphine and Fentanyl in my box as standing order drugs. Is this not the case most places?

True, true, neglected to consider the I-99. AEMT is somewhere in-between, I suppose. CT doesn't really use any EMT-I/AEMT skills other than IV placement, which is unfortunate, because EMT-Is/AEMTs have lots of useful skills in the National scope.

 

[EMT91]

I will address this by PM.

In response to you and the others I am and have been for the past four days or so been working on an essay of sorts explaing asa. I do wish to expand my knowledge and if I seemed rude or demanding I sincerely apologize.

 

[Doczilla]

It's not rude, but you're making a common mistake. The best way to remember meds is understand the concept, not just memorize facts. Understand the physio first, then your medication in question will make sense. If you understand the concept--- indications , contraindications, and adverse effects become obvious.

If you just memorize drug facts, you will dump it in an emergency. Trust me on this.

After you know this medication, answer me this please:

Why is ASA a vasodilator?

 

[Craig Alan Evans]

Pain management in the prehospital setting has been classically under dosed and underutilized. Systems are sending BLS units to fractures, abdominal pains, an back injuries. These are three things that almost always require some form of pain management. Anything we can do to allow more providers to administer pain medications will benefit the system and the public we serve. So yes, if you can start an IV then you should be able to give pain medications through the IV. I'm sure you carry nalaxone so realistically the risks are minimal. And everyone should be using nitrous oxide. BLS providers can very safely administer nitrous oxide.

 

[Veneficus]

And everyone should be using nitrous oxide. BLS providers can very safely administer nitrous oxide.

Tell the FDA that. They are the ones that made it so restrictive nobody carries it.

Also if I could just comment on narcan as a reasonable treatment.

If you reverse opioids you were administering for pain, then the pain comes back and the patient will probably have to suffer the 20 or so minutes until it wears off.

It is never done post surgery anywhere I have been for that very reason, best to just ventilate the pt.

 

[Craig Alan Evans]

Tell the FDA that. They are the ones that made it so restrictive nobody carries it.

Also if I could just comment on narcan as a reasonable treatment.

If you reverse opioids you were administering for pain, then the pain comes back and the patient will probably have to suffer the 20 or so minutes until it wears off.

It is never done post surgery anywhere I have been for that very reason, best to just ventilate the pt.

The FDA does not have unreasonable restrictions on the medical uses of nitrous oxide. It is definitely not so restrictive to make it prohibitive for prehospital treatment. I'm not sure where you are receiving your information from but I assure you that is not the case in Virginia. Many states have adopted laws regarding the human consumption of nitrous for recreational use but it remains a main stay in dentists offices, especially pediatric dentists and is a viable option for prehospital use. The limitation as listed above is with the delivery device. Not the gas itself.

As for your comments concerning narcan there are inherent risks with ventilating a patient for the 20 minutes needed such as gastric distention, vomiting, and aspiration. These complications are more prevalent with BLS providers. I believe in the case of administering too much narcotic it is a viable option to slowly reverse the effects to maintain respirations. Why would I want to ventilate a patient for 20 minutes when I can titrate .2-.4 mg of narcan and return their respiratory drive to normal while maintaining the pain reducing effects of the drug. If your argument holds true for all narcotic overdoses then we should be intubating all of them and just waiting for the effects of the drug to wear off. I see your point but I'm not buying it for prehospital medicine.

Once again I enjoy the yin yang discussions we seem to always get into.