Theoretical/Practical Pain Management Question

Veneficus said:
I don't think it is as simple as "non-life threatening pain" I think it is more in the realm of would a reasonable person expect care.

Let me complicate the example.

If a teenage baby sitter brings a minor into a healthcare facilty with a nonlife threatening injury or illness, like vomiting, or perhaps a laceration benefical from suturing, etc, and the parents cannot be contacted for whaever reason, we don't bounce those people out the door or make them wait. (Usually it is a grandparent or somebody else without "legal" guardianship other than being a relative)

We use implied consent as cover for what a reasonable person in such a situation would want.

People don't need sutures emergently. People do not often need antibiotics or a prescription for such that moment. They don't even likely need a medical eval.

Not having a complete history is also bogus in my opinion. I often do not have a complete or any history at all. BUt I don't have a seizure and then stop taking care of the patient.

I am also a little unsure about the idea of using pain as a non-life threatening condition delaying an MD evaluation.

How many agencies begin treatment of chest pain on scene? How many of you will not begin treatment of chest pain on scene for the purpose of driving to the hospital first to shorted time to an MD evaluation?

In many cases whether or not that chest pain is life threateneing or not is known after the fact, not when you are treating it.

GO ahead and tell me that if you had an elderly lady complaining of chest pain and the 12 lead didn't show a STEMI that you would sit on your hands until a doctor looked at her and somebody ran a troponin.

Pain is a medical condition unto itself. Without cell damage, there is no pain.

Deciding against treating somebody to the best of one's ability because the patient is "not emegergent" sounds like a an excuse not to get involved raher than a legal question to me.

Certainly it is a half-assed job.

It sounds in this instance it would be better to remove the MD from initial contact and make it an EMS only poperation.
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two points -

The first is the cast majority of the time we "Stay and play" on scene with someone after we figure out it is not life threatening is with an adult. I have never tinkered in the back of an ambulance with a 10 year old for the sake of starting an IV or getting a complete patient history, it would simply put me or the other persons working in a bad position.

second -
In the court system you can justify chest pain as possibly life threatening. You can justify shortness of breath as possibly life threatening. You can justify abdominal pain as possibly life threatening. You can justify a headache as possibly life threatening.
But justifying delaying transport to treat pain that you have already ruled out as non life threatening on a minor with no informed consent, that is different...

The more I think about this situation the more I think it is damned if you do damned if you don't. I think you could probably find a judge who would rule against you for not providing "Reasonable" treatment. But I also think you could find a judge who could rule against you for providing "uneccesary" treatment to a minor without informed consent. Crazier things have happened in America


I still think the easy solution is to contact medical control, present the two options for treatment and transport, and throw the decision on him.


I am going to find the discussion we had on age related refusal of treatment in a bit, breakfast time first.
 
Rialaigh said:
two points -

The first is the cast majority of the time we "Stay and play" on scene with someone after we figure out it is not life threatening is with an adult. I have never tinkered in the back of an ambulance with a 10 year old for the sake of starting an IV or getting a complete patient history, it would simply put me or the other persons working in a bad position.

second -
In the court system you can justify chest pain as possibly life threatening. You can justify shortness of breath as possibly life threatening. You can justify abdominal pain as possibly life threatening. You can justify a headache as possibly life threatening.
But justifying delaying transport to treat pain that you have already ruled out as non life threatening on a minor with no informed consent, that is different...

The more I think about this situation the more I think it is damned if you do damned if you don't. I think you could probably find a judge who would rule against you for not providing "Reasonable" treatment. But I also think you could find a judge who could rule against you for providing "uneccesary" treatment to a minor without informed consent. Crazier things have happened in America


I still think the easy solution is to contact medical control, present the two options for treatment and transport, and throw the decision on him.


I am going to find the discussion we had on age related refusal of treatment in a bit, breakfast time first.
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I wouldn't leave it up to a judge. I would demand a jury, and I would parade an army of witnesses to testify they would never want their kid to suffer in pain, life threatening or not.
 
I recently nuked kidney stones. 13 y/o M, about 150 pounds of Oklahoma farm boy. 4mg morphine + 2mg 10 minutes later. Pain 10/10 screaming to 0/10 = happiness.
 
Rocketmedic40 said:
I recently nuked kidney stones. 13 y/o M, about 150 pounds of Oklahoma farm boy. 4mg morphine + 2mg 10 minutes later. Pain 10/10 screaming to 0/10 = happiness.
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That is not nuclear. It is right in line with 0.1mg/kg dose.
 
Dwindlin said:
I would take the judge every day of the week. . .
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Not me. It is hard to manipulate the emotions of a judge.

Give me 12 people who couldn't get out of jury duty who are so likely to make decisons based on emotions I would manipulate them like puppets.
 
Veneficus said:
Not me. It is hard to manipulate the emotions of a judge.

Give me 12 people who couldn't get out of jury duty who are so likely to make decisons based on emotions I would manipulate them like puppets.
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Those emotions are way more likely to bury you than help you. Medmal in general would be better off as a bench trial. By the letter of the law malpractice should be essentially impossible to prove, problem with a jury trial is they can get away with voting how they want regardless if malpractice has actually been proven. Judges on the other hand do not. There is a reason the plaintiffs almost never choose the bench trial. . .
 
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For the people expressing their concerns over a possible lawsuit resulting from the treatment of a child's pain...Can you cite any cases where such a thing has resulted? I simply have a hard time believing that it would occur. Perhaps I haven't been exposed to that litigious of a community in my years. I'm aware that there are a large number of frivolous lawsuits out there, but really? (Incredulous, not condescending)
 
MediMike said:
For the people expressing their concerns over a possible lawsuit resulting from the treatment of a child's pain...Can you cite any cases where such a thing has resulted? I simply have a hard time believing that it would occur. Perhaps I haven't been exposed to that litigious of a community in my years. I'm aware that there are a large number of frivolous lawsuits out there, but really? (Incredulous, not condescending)
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That is pretty much my take on it.
 
MediMike said:
For the people expressing their concerns over a possible lawsuit resulting from the treatment of a child's pain...Can you cite any cases where such a thing has resulted? I simply have a hard time believing that it would occur. Perhaps I haven't been exposed to that litigious of a community in my years. I'm aware that there are a large number of frivolous lawsuits out there, but really? (Incredulous, not condescending)
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I know in the hospital setting we have dealt with several inpatients that were minors and many more that were adults who felt it was against their religious (or other) beliefs to have this type of medication or this type of treatment. I know this more commonly occurs with the use of blood and blood products but we have had people refuse blood pressure medications and sleep aids on the premise that they don't wish to "alter" their body with medicine...

why they come to a hospital is beyond me but...



Again, my issue is not so much the treatment of pain. It is the fact that treating a non-life threatening emergency for a minor is causing an additional 45 minute delay in this situation. I think the treatment coupled with the delay makes it a much more complex issue.
 
Rialaigh said:
Again, my issue is not so much the treatment of pain. It is the fact that treating a non-life threatening emergency for a minor is causing an additional 45 minute delay in this situation. I think the treatment coupled with the delay makes it a much more complex issue.
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I am not sure what makes this an emergency at all.

It is a dislocation.

As time goes on, the muscles will likely relax from the initial spasm, which makes it easier to reduce over time. Opioids and Benzos will also help this.

You can have a patient with a dislocation for days before reducing it. (my personal record is a pt who came in with a dislocation 7 days after the event) Who gives a crap about 45 minutes and why?

What if this person was laying on the ground instead of seen by an MD and the nearest responder was 45 minutes away?

The fact this person is in medical care makes this a interfacility transport not an emergency transport.
 
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