the 100% directionless thread

3 days at Great Wolf Lodge. I'm ready to head home to have just one kid yelling at me, instead of 800. :)

Really a great time. If you've got kids, highly recommended. Just bring your own food and snacks. :)
 
Just had my first patient ask for dilaudid by name "4 MG IV push....or morphine 10mg IV push"....
 
CALEMT said:
Medic school from 9-6 for me.
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Break a leg...then splint and treat for pain.
Jim37F said:
Just had my first patient ask for dilaudid by name "4 MG IV push....or morphine 10mg IV push"....
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What was their medical hx?

Over the years I have learned that many times their disease process may validate such therapies; not all, but some.
 
Been quite a bit of time since I've been back to school hopefully they don't bully me


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DEmedic said:
3 days at Great Wolf Lodge. I'm ready to head home to have just one kid yelling at me, instead of 800. :)

Really a great time. If you've got kids, highly recommended. Just bring your own food and snacks. :)
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I'm going to have to check out that one they opened up in SoCal now. I hardly doubt our toads will disapprove.
 
Somebody (QA/QI) modified my chart to include "HIPPA" form acknowledged by patient...

"Q"A...
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Jim37F said:
Just had my first patient ask for dilaudid by name "4 MG IV push....or morphine 10mg IV push"....
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Or 100mg of Nopeazine. Hahah.

If somebody specifically tells me how much of a narcotic they need, my spidey sense starts to tingle. And maybe they'll get a couple mg of morphine and phenergan, but ain't no way I'm gonna give anyone 4mg of Dilaudud who can ask for it by name.
 
@DEmedic, sickle crisis? That's the only thing I can think of painful and recurrent enough to maybe warrant asking for opioids by name.
 
EpiEMS said:
@DEmedic, sickle crisis? That's the only thing I can think of painful and recurrent enough to maybe warrant asking for opioids by name.
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This was my thinking, too. These patients often get a bad rap, but then there are those that have truly become opioid dependent as a result of the inevitable crisis.

If I am running on you more than once/ week for a "crisis", it often becomes less of a crisis as time passes. Are they in pain? Arguably, yes. Will I treat their pain with narcotics every single time? Arguably, no.
 
EpiEMS said:
@DEmedic, sickle crisis? That's the only thing I can think of painful and recurrent enough to maybe warrant asking for opioids by name.
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Yeah. Okay. Fair enough. I have a frequent flyer that is a sickle cell patient. He gets 2 liters of fluid and 4mg of morphine during the transport and that usually is enough to get him comfortable.
 
DEmedic said:
Yeah. Okay. Fair enough. I have a frequent flyer that is a sickle cell patient. He gets 2 liters of fluid and 4mg of morphine during the transport and that usually is enough to get him comfortable.
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He still has good vascularity? Most (IME) often don't, given their condition. Maybe a PICC line to acess, or IM/ IN analgesics.

What's the FB for? That's new to me. Is usually fairly dry?
 
VentMonkey said:
He still has good vascularity? Most (IME) often don't, given their condition. Maybe a PICC line to acess, or IM/ IN analgesics.

What's the FB for? That's new to me. Is usually fairly dry?
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Yeah. This guy usually waits until he's been vomiting for several days and can't rehydrate himself. Usually really poor skin turgor, dry mucosa and a crappy BP. It's 45 minutes to the ED and by the time I get there he's feeling like a new man. When a new guy goes to his residence, one of the senior medics will call and say "Tim needs fluid and some morphine".

I know that a fluid bolus in SCC is usually a no go, but it never fails that this guy needs a bag or two.

Got a fair number of comorbidities too.
 
EpiEMS said:
Ah, yes. Progressive EMS at its finest ;)
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We can, however, administer IN Fentanyl. I a decent option when vascular access is unobtainable that is often overlooked.
 
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