Toradol

[Dwindlin]

I think only having narcotics to treat pain is ridiculous. Even chronic back pain should be treated. "Suck it up" and "you can wait" doesn't seem like a treatment plan to me.

Perhaps not by a narcotic, but if you have nothing else, it seems a bit inhumane to just watch the person suffer. Just my opinion.

I think medical direction that only permits the use of narcotics might be a bit lacking.

Well that is the reality for a large number of departments/services. And I am in total agreement with Farmer2DO, not everyone with "10/10" pain is getting a narc, which is my only option pre-hospital, they will get assessed and treated based on both subjective and objective findings.

 

[Veneficus]

Well that is the reality for a large number of departments/services. And I am in total agreement with Farmer2DO, not everyone with "10/10" pain is getting a narc, which is my only option pre-hospital, they will get assessed and treated based on both subjective and objective findings.

So are there are times when in your assessment you find the patient has pain, but you do not treat it?

 

[DrankTheKoolaid]

Well that is the reality for a large number of departments/services. And I am in total agreement with Farmer2DO, not everyone with "10/10" pain is getting a narc, which is my only option pre-hospital, they will get assessed and treated based on both subjective and objective findings.

And what objective findings would those be?

 

[RocketMedic]

So are there are times when in your assessment you find the patient has pain, but you do not treat it?

Yes, but it depends on the patient presentation.

 

[Veneficus]

Yes, but it depends on the patient presentation.

like what?

 

[mycrofft]

metacommunication

Thread's getting tangled, people are restating each other, repeating themselves, and way off base answering about toradol.
How about anther thread or go PM? Chat?

 

[Farmer2DO]

Thread's getting tangled, people are restating each other, repeating themselves, and way off base answering about toradol.
How about anther thread or go PM? Chat?

You're right. Before going back to the original topic, I will tell a story that one of my favorite ED nurses uses:

"Sir, what is your pain, on a 1-10 scale? Bear in mind, 5 is being hit by a car."

What would be some other reasonable choices? PO agents, like acetaminophen, aspirin, ibuprofen, or narcotic combinations like vicodin or percocet? Or an IV agent like toradol?

 

[Scott33]

IV acetaminophen is being used to good effect in parts of Europe.

 

[Doczilla]

I've seen the local docs in D-bagistan give I.V NSAIDS like duflunisal, seemed fairly effective... though by the time they got to us, they had deteriorated to the point where the only viable non-opiate path was to put them in a K-hole.

But back to Toradol, I can speak from experience that it works pretty well. I got my calf crushed in a 800lb. MRAP door, and I was continuing the mission 60mg of toradol later.

 

[bigbaldguy]

I've seen the local docs in D-bagistan give I.V NSAIDS like duflunisal, seemed fairly effective... though by the time they got to us, they had deteriorated to the point where the only viable non-opiate path was to put them in a K-hole.

But back to Toradol, I can speak from experience that it works pretty well. I got my calf crushed in a 800lb. MRAP door, and I was continuing the mission 60mg of toradol later.

And doczilla grabs the wheel and wrestles the train back onto the tracks for a last minute save. Nicely done.

Try to keep it on track guys remember the topic is toradol.

 

[epipusher]

Speaking of Toradol, I treat all physical pain with some sort of medication. Be it oral Tylenol, oral or IV Toradol, or IV Fentanyl. I assess the level of the pain, not the sincerity of their story or how many times they have called.

 

[Farmer2DO]

Thread's getting tangled

You're right.

But back to Toradol, I can speak from experience that it works pretty well. I got my calf crushed in a 800lb. MRAP door, and I was continuing the mission 60mg of toradol later.

Try to keep it on track guys remember the topic is toradol.

Isn't that what we were doing all on our own?

 

[TheLocalMedic]

Dwindlin, Farmer2DO, you are both after my own heart. Pragmatism and critical thinking are some of the most important things for a medic to learn, and often they are learned over time. Sometimes the mark of a decent paramedic is knowing when or what not to treat, i.e. the "stubbed toe complaining of 10/10 pn"... ahem...

Narcotics are obviously a touchy subject, but being that those are all that many systems have to deal with, I can understand why some might say that narcs are their go-to treatment the minute a pt says "boo". I don't agree with that, but I can see it from their viewpoint... dimly...

As for Toradol, frankly I can understand why many systems do not allow their paramedics to administer it. Clearly if medics think it's okay to give a narc for any old thing, then why should they hold back from giving Toradol to a pt with a trauma complaint or any other complaint involving hemorrhage? Okay, I know that there are a lot of smart medics out there who know better, but there are also clearly medics out there who do not critically examine their patients and may not be able to differentiate who is or is not a good candidate for Toradol as opposed to a narcotic.

 

[Veneficus]

As for Toradol, frankly I can understand why many systems do not allow their paramedics to administer it. Clearly if medics think it's okay to give a narc for any old thing, then why should they hold back from giving Toradol to a pt with a trauma complaint or any other complaint involving hemorrhage? Okay, I know that there are a lot of smart medics out there who know better, but there are also clearly medics out there who do not critically examine their patients and may not be able to differentiate who is or is not a good candidate for Toradol as opposed to a narcotic.

I am not sure I agree with this fully.

It is just my speculation, but I think the reason most systems have only narcs is becuase there is this crazy idea that people only call ambulances for emergencies.

So if an ambulance and pain are involved somebody must think the patient must be serious enough to warrent narcotics.

This could be be propagated by "what is everyone else doing" medical direction or systems where the medical director buys a premade set of protocols and signs them off as his own without any more effort or thought.

Since most trauma is muscle/skeletal it should respond rather well to toradol. Even a fracture.

If a medic is giving somebody with a serious bleed toradol because they don't know better, I would think they are just as likely to givethe narc in the same instance.

As long as the patient in't complianing of head pain, vomiting blood, or chest/abd pain raidiating to the back with signs of shock, the risk of improper toradol use is rather insignificant.

I guess I just think that the prolem isn't aggressive pain treatment, the problem is not treating pain, but anyone who only has narcs is going to have to choose between doing something and doing nothing.

EMS needs to have treatments available to deal with the patient population they actually see. Not just the perception of who they should be seeing.

I have it quite unacceptable a teenager can walk into a store and buy all kinds of crap off the shelf from everything from sore throat to menstrual relief (that has both asa and tylenol usually in the mix) But the people working on the ambulance have only the option of a narc or an injected NSAID.

I think it much more appropriate to treat the 10/10 toe pain etc with an oral nsaid than with a needle of anything.

I just find it more detestable to leave somebody who is obviously struggling in pain.

I am not suggesting giving narcs to seekers with a BS story. I a suggesting that if the patient is an abuser and has pain, then if that means narcs, treat the pain.

I attempted to start a philosophical argument on whether or not palliating seekers was a reasonable medical therapy, but it didn't get anywhere other than to have a bunch of chest pounding about assessment.

 

[Aidey]

I am not sure I agree with this fully.

It is just my speculation, but I think the reason most systems have only narcs is because there is this crazy idea that people only call ambulances for emergencies.

For ages we didn't have saline locks, because the prevailing opinion was that if the pt was bad enough to need an IV, they needed fluids.

 

[Doczilla]

Toradol isn't even that bad for bleeds. The effect is reversible, and only lasts about half as long as ASA, if it DOES affect anything.

 

[TYMEDIC]

Because who needs ethical behavior...

hahaha

 

[ah2388]

The take home point from this thread for me is that we should not be writing patients off because they are "system abusers as, these individuals do sometimes have legitimate complaints including pain.

While it may be difficult, we should be approaching these patients as "first time patients" while keeping in mind that these patients often have glaring holes in the story which we (hopefully) have gathered in a diligent manner.

I have found in my limited experience that these patients often times benefit from hot/cold or positional adjustment.

I have administered toradol with good results, especially in conjunction with other agents.

 

[RocketMedic]

With the current shortages, I personally try and use toradol to compensate for musculoskeletal pain where I would consider morphine in some patients (ie isolated fracture).

 

[EMSpursuit]

Yea the drug seekers like the stronger stuff...i have noticed they all say they are allergic as well to negate the Doc prescribing them it.