the 100% directionless thread

[Shishkabob]

I don't doubt that she was in pain... I doubt it was severe 8/10 sharp/stabbing "almost worst pain of my life" kind of pain that required Morphine.

Correct, I can't prove one way or the other that they are or are not in pain, and I tend to err on the side of the patient. However, it is my job, as someone in control of narcotics, to decide who does or does not get them. My experience may be limited, but it's not non-existent.


Heart rate normal, BP normal, no increased ventilatory rate, no grimace on the face, none of the classic signs of pain at ALL, let alone for an "8/10 sharp stabbing, horrible" type of pain. Not on beta blockers that would explain the lack of catecholamine signs either.

Yet, when I poke a nice juicy AC, which I can guarantee was not a tendon stick, and THAT causes some of the classic signs of pain, somethings up.


This is why I love Nitronox... every truck should carry it.


You don't give narcotics to every patient that claims 5/10 or higher just because they say so, do you? You look for clinical signs.




PS-- I have needle phobia myself... I can still differentiate between a needle stick and "8/10" pain... and no needle stick has ever caused me to go from an ambient 8/10 to an excruciating 9/10 or 10/10

 

[Sasha]

Oh I forgot, everyone behaves the same as you.

 

[Shishkabob]

So I was wrong to deny narcotics to 8/10 abd pain due to absolutely no positive clinical findings?


What are your criteria for administration of narcs? Or does everyone with any sort of discomfort get Morphine, regardless of your professional opinion and findings?

 

[8jimi8]

So I was wrong to deny narcotics to 8/10 abd pain due to absolutely no positive clinical findings?


What are your criteria for administration of narcs? Or does everyone with any sort of discomfort get Morphine, regardless of your professional opinion and findings?

correct, Linuss, you were wrong. Even if you get 10 people "high" off o your narcs - and only one REALLY needs it. It is ok. Don't deny pain medicine to people. I'm not saying, dont discern, I'm saying don't judge and hope that people believe you, if you ever need it. Clinical signs or not, If you are witholding analgesia. You will eventually hold It for the wrong person. Once you've done that, are you still practicing "do no further harm?". This is an issue I deal with daily in the hospital. I work at the county, so you know our population is indigent. We have a large percentage of patients who are high alert drug seekers. We still give them narcs on heir prescribed schedule. You'll know they are faking when they are only allergic to non-narcs... Or when they ask you to slam it undilluted. Some people just don't show clinical signs of pain and until you can diagnose them as faking, you are practicing bad medicine by witholding analgesia.

 

[Shishkabob]

Whelp, here is me officially disagreeing with you.


Do you give narcotics to every patient that claims 1/10 pain? If I come to your hospital with a stubbed toe, no fractures, I'll be expecting narcs, right?

If not, than you cannot stand by the post you just put.



Read back 1 weeks time in this thread and you'll see how PISSED I got when I couldn't give narcotics to someone that needed them. Obviously I'm not stingy on meds. I just question how much pain a 22g needle causes to someone claiming to already be in almost the worst pain in their life... you wouldn't wonder that either?

 

[8jimi8]

the lowest pain i've given narcotics for was 2/10. i gave 1 5/325 norco.


i have given 1mg MS for 4/10 pain.

Don't worry, you'll learn. Maybe you didn't make the wrong call this time, but give it some time and you may.

Your license, not mine

(and you are my friend - i'm not mad at you and i don't expect you to agree with everything I say!)

 

[Shishkabob]

I will beat yoU!!! Rawr



Patient was already on Norco 10/325 3 times that day, one just a couple of hours before we were called. Granted, PO narcs... but still.



Let me add a caveat though: I don't follow just the pain scale... if someone has a leg fx, but only says 3/10, obviously they are in pain. I take the injury into account. Heck, dull chest pain, 2/10 with no relief from Nitro will also probably get Morphine. It's not just the number, but the whole picture, that I take in to account. Clinical findings, injury, pain scale, the patients wishes, all have their part.



For the one you gave MS for 4/10, what was their presenting injury?

 

[DaniGrrl]

My Dad, an editor who was laid off two years ago by the McClatchy newspaper he worked for, just got hired for a full-time editor job with a great salary and his own office! No more unemployment, no more job searching, no more living in their friend's basement, no more relying on Medicaid which won't cover his diabetes meds, no more of my 60 year-old mother having to haul boxes to keep her part-time retail job. I can't even tell you how wonderful this news is. My parents have both been out of work for over a year. They lost their house to foreclosure. It's been really bad. Now they can start living again.

 

[Trayos]

My Dad, an editor who was laid off two years ago by the McClatchy newspaper he worked for, just got hired for a full-time editor job with a great salary and his own office! No more unemployment, no more job searching, no more living in their friend's basement, no more relying on Medicaid which won't cover his diabetes meds, no more of my 60 year-old mother having to haul boxes to keep her part-time retail job. I can't even tell you how wonderful this news is. My parents have both been out of work for over a year. They lost their house to foreclosure. It's been really bad. Now they can start living again.

Congratulations!

 

[TransportJockey]

I can finally have Epocrates on my phone Just upgraded to Android 2.2

 

[firetender]

This is why I read the 100% directionless thread (sometimes)!

My Dad, an editor who was laid off two years ago by the McClatchy newspaper he worked for, just got hired for a full-time editor job with a great salary and his own office! No more unemployment, no more job searching, no more living in their friend's basement, no more relying on Medicaid which won't cover his diabetes meds, no more of my 60 year-old mother having to haul boxes to keep her part-time retail job. I can't even tell you how wonderful this news is. My parents have both been out of work for over a year. They lost their house to foreclosure. It's been really bad. Now they can start living again.

Getting to know you on this site makes this worthwhile reading, and because of it it's a little bit easier to appreciate the human side of some of the things we get exposed to in the back of the ambulances. Such pressures can be deadly and I'm happy for you and them that the pressure is lifting!

 

[Shishkabob]

Was cleared from my FTO on Monday, and got my FT schedule... Mon/Wed 1500-0300, and every other Fri/Sat/Sun same times.


My first shift as a lone Paramedic (with EMT partner) is tomorrow where I'm doing standby at the horse races.

 

[8jimi8]

I will beat yoU!!! Rawr



Patient was already on Norco 10/325 3 times that day, one just a couple of hours before we were called. Granted, PO narcs... but still.



Let me add a caveat though: I don't follow just the pain scale... if someone has a leg fx, but only says 3/10, obviously they are in pain. I take the injury into account. Heck, dull chest pain, 2/10 with no relief from Nitro will also probably get Morphine. It's not just the number, but the whole picture, that I take in to account. Clinical findings, injury, pain scale, the patients wishes, all have their part.



For the one you gave MS for 4/10, what was their presenting injury?

it was a long standing bout with pancreatitis. And i forgot it wasn't MS, it was 1mg Hydromorphone.

One little thing I want to point out to your patient (who may or may not have been a drug seeker)

If someone is on 10/325s tid at home that means they have SERIOUS pain. What doc is going to prescribe someone so much norco?

I'm gonna have to say i still disagree with your call (lol - like it matters)

but i will redirect you to a quote from Bob Marley. "who feels it, knows it." I'm telling you man, you gotta be more humane to your patients. If you ever do go on to nursing school, you will find that this is one of the fundamental points taught in school. Always medicate pain, DON'T EVER not believe your patients.

 

[lightsandsirens5]

What doc is going to prescribe someone so much norco?

Wellllll........................I can think of some.

 

[mycrofft]

Note the entry time.

I'm sitting here with a teabag string hanging out of my mouth, a Vicodin in my sytem, ice on my jaw and typing in sarcastic replies to EMTLIFE.
At least I HOPE this is EMTLIFE.
Next time, I'm d/c'ing the warfarin a little farther out before the oral surgery.

 

[Sasha]

mycrofft, what did I tell you? Take your aricept!!!!

 

[DaniGrrl]

Thanks, firetender.

My hard drive just died. I telecommute, so that is a very bad thing. Le sigh.

 

[Sasha]

As to Linuss... If a patient tells me they are in pain, and the pain is not relieved by non invasive methods, repositioning, packs, and the patient wants pain meds, they get morphine. It is not my job to diagnose a junkie and send them into withdrawal, it is my job to treat my patient's pain, and they have a right to have it treated, imagined or not. You simply don't know if the patient is in pain or not, you have no way of knowing, you are not their sensory nerves, the pain is happening in their body, not yours.

My protocol says for pain give such and such, not "For pain if patient is not a suspected junkie, and you feel they are reacting correctly, give such and such"

Maybe I feed a junkie once in awhile, but I am not going to risk leaving a patient in pain to play catch the drug seeker. I take my job as a patient advocate seriously. If someone tells me they're in pain, why risk it by not believeing them?

 

[JPINFV]

Hmm.... maybe House of God is onto something... out of three systems so far, I like psych the best...

 

[Sasha]

Hmm.... maybe House of God is onto something... out of three systems so far, I like psych the best...

Psych patients can be interesting... Half the time they're trying to fly off the stretcher and kill you. Always makes for an exciting transport.