Toradol

Tigger

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We recently started carrying Toradol. Have personally had it for spinous process fractures and it was quite effective, others report the same for kidney stones. Anyone else have any tips, tricks, or conditions that they find it especially useful for? 15mg IV/30mg IM.
 

spimx

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How long are your transports? ketamine is pretty popular now. I'm not a big fan of it but I also don't like to treat pain unless I see musculoskeletal deformity or dislocation
 
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Tigger

Tigger

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How long are your transports? ketamine is pretty popular now. I'm not a big fan of it but I also don't like to treat pain unless I see musculoskeletal deformity or dislocation
Frankly I think that is a pretty terrible attitude towards treating pain. There’s a lot of non-traumatic causes of pain that while not life threatening are worthy of your paramedic treatments. What is your reasoning here?

Our transports are 20 minutes, longer to some other receivings.

We have Ketamine and for trauma and I love it. Also fentanyl and we are allowed to mix with Valium or versed if needed for spasm and/or anxiety. And finally PO acetaminophen and ibuprofen.
 
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akflightmedic

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How long are your transports? ketamine is pretty popular now. I'm not a big fan of it but I also don't like to treat pain unless I see musculoskeletal deformity or dislocation

You must have xray vision then...?? Have personally treated many fractures and dislocations with no deformity obviously noted, yet still creating pain. Can you expand on why you feel you know better than the patient whether their pain is real or not? Can you expand on what criteria or threshold they must meet before you decide to give them relief? And why such a withhold attitude? Does administering pain relief require you sacrificing your first born or paying for it yourself?
 

Fastfrankie19151

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How long are your transports? ketamine is pretty popular now. I'm not a big fan of it but I also don't like to treat pain unless I see musculoskeletal deformity or dislocation
Please please tell us where you got this super Ems X-ray vision that allows you to see through akin to make sure the patient doesn’t have a broken bone etc.
 

E tank

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Some historical perspective for interest only...

The dose used to be 30 to 60 mg. We did that until we began to notice that some post surgical patients stopped making urine, especially those that were at higher risk for post operative renal dysfunction like big blood loss and prolonged procedures (>3 hours or so). Then there was some voodoo studies about bone healing and nsaids which some orthopedic surgeons glommed onto which really reduced toradol's popularity. That and observational data that implicated it in increased bleeding because of it's impairment of platelet function. Finally some studies came out demonstrating that 15-30 was as effective as 30-60mg and it slowly has been making a come back in analgesia adjunct therapy.

Now there is IV tylenol which is pretty effective too but comes in a 50 cc bag which is more of a hassle than an IM shot....lot's of non narcotic analgesia to choose from....

FWIW....
 

Akulahawk

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I'm a pretty decent fan of Toradol IM or IV. It seems to work pretty well in most people and seems to be nearly the cat's meow for kidney stones. We don't normally do IV tylenol but those times I've administered it, the stuff seemed to be quite decently effective. Pain-dose ketamine is probably underutilized, but I don't think it should be a 1st line pain drug, but those times I've given ketamine for pain, it seemed to work very well too.
 

TransportJockey

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I give it a lot for abdominal pain in conjunction with IV APAP. Works like a charm for suspected renal cholic or gallbladder issues.
I also will use it as first line, again in conjunction with IV APAP, for probably soft tissue injuries w/out deformities.
 

Carlos Danger

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For most types of moderate to severe acute pain, I believe it is highly overrated as a sole agent. You frequently hear folks refer to studies that show that 30mg of ketorolac is equivalent to 10mg of morphine, but I've always questioned the reality - or at least the reliability - of that equivalence. I wonder if the authors of those studies (or those who cite them) would be content with toradol as the sole analgesic following any type of abdominal surgery, for instance? We all know the answer to that. And this coming from someone (myself) with almost 6 years of experience doing opioid-free (not multimodal, or opioid-sparing....opioid FREE) anesthesia and acute pain management. Thinking about the mechanism of ketorolac vs opioids, it just doesn't make sense that it could ever work as well as an opioid for severe pain.

That said, it is awesome as the sole agent for most types of mild-moderate pain, or as an adjunct for moderate-severe pain. I think in EMS there is probably a lot of opportunity to try it before pulling out the fentanyl or ketamine if the pain is not severe, and if the dose of toradol does not provide sufficient analgesia, then if nothing else you can probably at least cut your narcotic dose in half to start.
 

johnrsemt

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Toradol works great for Kidney stones, nothing else we carry will work for them.

Spimx; I am glad you don't work for me or with me.

Had a patient yesterday, 11 y/o female, was pushed into a couch. Hit her lower right rib cage on the wooden corner of the couch. She was screaming in pain. No rib deformity. No pain, tenderness or guarding in abdomen in any quad.
I gave her 300mcg of Fentanyl during transport (45kg, x 1mcg/kg = 50mcg dose, 6 doses) during the 140 mile transport.
Her mom called me this morning: No broken ribs, she had a lacerated kidney: they are keeping her in the children's hospital for a few days to see if she needs surgery, on a Morphine drip.

If a patient is in pain, that is something we can fix; and it is easy to fix; why not fix it? Why make people suffer?
 

Phillyrube

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Used a lot of it in the ED I worked at. Amazing how many people are allergic to it and the only drug that works is that one that starts with a "D".
 

StCEMT

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It's been hit or miss for me. Some people say it didn't do a damn thing for them, others say it worked great. I've been re-exploring it here the last few months actually. My final verdict is still out, but so far I'm gonna keep pushing it's use more for a bit. That being said, a lot of people lately have been requiring fentanyl so it hasn't been on the forefront as of recent.
 

jgmedic

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It is magic for kidney stones, as I have experienced myself on multiple occasions. I think it would be nice to have as kind of a halfway between IV Tylenol and fent
 

johnrsemt

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Anyone carry Nubain? My PT job carries it for Advanced EMT's on the Nevada Protocols, but it can be used on the Utah side and by the Medics we all use it for Kidney stones, and it works pretty good for that too.
It works great for confusing the doctors and nurses at the ED's too.
 

akflightmedic

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Wow....I had totally forgotten about Nubain, have not seen it, carried it or even used it since late 90s, maybe early 2000s...do they still make it? LOL
 

E tank

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Little trick I've used when narcs a little over done and the post op patient isn't taking too many breaths is to trickle in a little nubain instead of narcan to keep from totally reversing the analgesia...Works pretty good sometimes...
 

FiremanMike

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Wow....I had totally forgotten about Nubain, have not seen it, carried it or even used it since late 90s, maybe early 2000s...do they still make it? LOL
Carried it when I was first hitting the streets, along with lidocaine, procainimide, bretylium, and verapamil, lol
 

akflightmedic

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Carried it when I was first hitting the streets, along with lidocaine, procainimide, bretylium, and verapamil, lol

Exactly!! I was like who the hell still carries this?? LOL And why????

I was sharing this drug with my SigOther who had never even heard of nubain, she is late to medical game, which led me to recounting one of my first cardiac arrests...ya know, when drugs went down the tube because could not get an IV. Along with escalating epi...hahahaha.
 

FiremanMike

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Exactly!! I was like who the hell still carries this?? LOL And why????

I was sharing this drug with my SigOther who had never even heard of nubain, she is late to medical game, which led me to recounting one of my first cardiac arrests...ya know, when drugs went down the tube because could not get an IV. Along with escalating epi...hahahaha.
I was just talking about escalating epi the other day while we were waiting on an arrest in the ER. I said we used to do 1,3,5, then 10mg, and wasn’t that after 1-2 rounds of giving 1:10? Man we used to slam that epi.
 

mgr22

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Did anyone else carry Decadron for EMD -- I mean PEA -- like we did in NYC?
 
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