Treat on scene or transport?

[OzAmbo]

I think he's reading too much into it as in " you might consider giving some pain relief, as if its a left field option"

Thats the way i took it, but i didn't think that was the case, hence the "i hope im reading into this too much" comment

but a couple of non specific points.....

Pain management is a mainstay of basic health care, to deny patients analgesia is inhumane and negligent at best.

A vast majority of patients we attend have pain as the chief complaint, and should be managed accordingly. Im constantly amazed at the lack of and sometimes aversion by ambo's to narcotic use.

Uncomplicated fractures and severe musculoskeletal pain and without major trauma who do not get adequate pain relief before movement and or splinting is wrong. And while ive mentioned splinting, if anyone truly thinks that "splinting reduces pain" as a method of primary analgesia needs to re-examine their priorities as spliting without analgesia is barbaric

Analgesia IMO should not be subject to half assed management based on an arbitrary scene time that realy makes no difference to a majority of patients. For your major trauma and time critical patients that really cannot wait then do what you need to do, but i think the industry uses those time critical patients to make an excuse for itself regarding lack of appropriate inervention for other patients

Leaving patients in pain because they can "tolerate it" is inexcusable in my opinion - i think i saw "load of crap" regarding this? If i did i like it.

Wong baker is a handy tool but should not be the only guide to pain assessment. If the patient says they have 10/10 pain but they dont have what you think is an appropriate facial grimace then your adding your own bias into the mix which actually reduces the validity othe assessment scales your using anyway

The urban legend of narcotics reducing the effectiveness of bedside assessment has been debunked long ago

If providers are chicken about about giving narcs based on possible allergies, complications etc" i'd have to say that your not familiar enough with the drug, inexperienced in its use, or unsure of your own history taking.

Side effects of narcotics can be managed if needed so refusing analgesia based solely on spidey sense with no information other than the idea that "they might have a reaction" probably says more about providers education or exprience than anything else

All my patients arrive at emergency with their pain managed as best as it can and within the limts set down by my clinical department. 40mg of morph or 200mcg of fent generally makes for a happy patient with controlled pain who wasn't a blubbering mess when they were splited, loaded and transported.

Not directed at anyone, just a general rant about recurring topics across multiple threads and forums

 

[RocketMedic]

Oz, you have to remember that we deal with many, many drug seekers here.

 

[usalsfyre]

Not always so. If your pt is definitely in ths lls ( looks like $hit) category you want a medic. But for 90% of trauma and 40% of medical, waiting for als is just b.s. When you get some time logged feel free to play within your scope

I'll remember this once I have one or two days on the ambulance...

 

[usalsfyre]

Oz, you have to remember that we deal with many, many drug seekers here.

Probably no more than anywhere else in the world. The difference is they're not hung up on it.

 

[Tigger]

Oz, you have to remember that we deal with many, many drug seekers here.

There are plenty of people that enjoy getting high on opiates in the southern hemisphere as well.

 

[Shishkabob]

Pain management is a mainstay of basic health care, to deny patients analgesia is inhumane and negligent at best.

A vast majority of patients we attend have pain as the chief complaint, and should be managed accordingly. Im constantly amazed at the lack of and sometimes aversion by ambo's to narcotic use.

I'm a big advocate of analgesia, but let's be honest here, in the US most systems only have access to narcotics for pain control. I'm not going to give a narcotic for most minor complaints of pain. That's not what I do.

"Oh, you've had a sore leg for 3 weeks? Well, here's 100mcg of Fentanyl!"

Leaving patients in pain because they can "tolerate it" is inexcusable in my opinion

In yours, not in mine. There are just some people who will always have pain, regardless of the amount of pain control applied. Hell, I will, and have, consciously sedate someone if I think it will benefit them, however if you state a 1 or 2, and it was initially a 9, I think job well done. If someone is still in pain, I ask if they'd like any more, and usually if they state 3 or less, they refuse further control. That's their choice.

Most of my treatment falls under implied/expressed consent. Not pain control. I work with the patient to find out what they like. If that's nothing, that's nothing. If that's ice, that's ice.

I had an auto/ped the other day where the patients legs were run over and they had significant swelling to their foot. An ice pack was all they required.

Wong baker is a handy tool but should not be the only guide to pain assessment. If the patient says they have 10/10 pain but they dont have what you think is an appropriate facial grimace then your adding your own bias into the mix which actually reduces the validity othe assessment scales your using anyway

If you say 10/10, or the much hated 11+/10, and I don't see anything else to match, I'm not buying it, sorry. A 10/10 abd pain with you not guarding, walking up straight, sitting in semi-fowlers just fine, and NOTHING else says pain aside from you saying "It's a 10", just doesn't fit, and I will stand by my decision. Hey, looks like you're handling the pain just fine.

I have yet to see a legit 9 or 10 that didn't elicit some form of physical manifestation. I don't care how tolerant of pain you are, a 9 or 10 will show itself in your actions, every single time.

 

[OzAmbo]

Answers in red mate

"Oh, you've had a sore leg for 3 weeks?"

I laughed my head of when i read that, because it nearly always goes something like...

"it doesn't hurt very much, but hurts really bad when i do this (bends leg)"..." what does it doe when you your sitting down or not standing on it?"...... Its fine, i mean ive been going to work with and taking some panadol but it only really hurts when i do this (bends leg again)".... " "how about you stop doing that then?"
In yours, not in mine. There are just some people who will always have pain, regardless of the amount of pain control applied.

True... especially those whith long standing chronic pain... we have a few frequent flier here who have oxycodone and durogesic patches and you just know that they already have a tolerance for what your about to give them, but we should still make the effort, and i know thats not what your saying, but there will be providers who go "nothing will work anyway, lets just load and go"

Most of my treatment falls under implied/expressed consent. Not pain control. I work with the patient to find out what they like. If that's nothing, that's nothing. If that's ice, that's ice.

I didn't mean to imply that i just shove narcs into everyone vein who has pain. If they are unprepared to accept narcs then obviously you use what ever methods are oppropriate, and i never discount the patients wishes. My comments were more about those who under medicate or withold it when its clearly needed based on "scene time" or concerns not based on clinical assessment

I had an auto/ped the other day where the patients legs were run over and they had significant swelling to their foot. An ice pack was all they required.

Cool (pun intended), no problems with that

If you say 10/10, or the much hated 11+/10, (why cant they just answer the question!!!! )

and I don't see anything else to match, I'm not buying it, sorry. A 10/10 abd pain with you not guarding, walking up straight, sitting in semi-fowlers just fine, and NOTHING else says pain aside from you saying "It's a 10", just doesn't fit, and I will stand by my decision. Hey, looks like you're handling the pain just fine.

Im with you there, but nearly always after clarifying the question they give you a different answer, at least in my experience. The ethical dilemma of who are we to refuse analgesia is long and has been done to death. I would rather err on the side of caution and give the narcotic than risk missing someone with legitimate pain

I have yet to see a legit 9 or 10 that didn't elicit some form of physical manifestation. I don't care how tolerant of pain you are, a 9 or 10 will show itself in your actions, every single time.

I disagree. Personal experience tells me that people are remarkably adept at hiding their pain. My old man had a workplace injury when i was in my teens, ruptered L3/4 discs and severe sciatica - ended up with a laminectomy. At his worst he walked with a stiff back and had a facial grimace but thats him, tough little :censored::censored::censored::censored::censored::censored::censored:... and he was always under medicated becuase he "looked like he was doing allright"

Also, im amazed at the tolerance people of asian decent have to pain, barely let out a whimper or a grimace :wacko:

Good posts mate, i think you and i are on the same plane

 

[Lfd128]

I'm a big advocate of analgesia, but let's be honest here, in the US most systems only have access to narcotics for pain control. I'm not going to give a narcotic for most minor complaints of pain. That's not what I do.

"Oh, you've had a sore leg for 3 weeks? Well, here's 100mcg of Fentanyl!"





In yours, not in mine. There are just some people who will always have pain, regardless of the amount of pain control applied. Hell, I will, and have, consciously sedate someone if I think it will benefit them, however if you state a 1 or 2, and it was initially a 9, I think job well done. If someone is still in pain, I ask if they'd like any more, and usually if they state 3 or less, they refuse further control. That's their choice.

Most of my treatment falls under implied/expressed consent. Not pain control. I work with the patient to find out what they like. If that's nothing, that's nothing. If that's ice, that's ice.

I had an auto/ped the other day where the patients legs were run over and they had significant swelling to their foot. An ice pack was all they required.




If you say 10/10, or the much hated 11+/10, and I don't see anything else to match, I'm not buying it, sorry. A 10/10 abd pain with you not guarding, walking up straight, sitting in semi-fowlers just fine, and NOTHING else says pain aside from you saying "It's a 10", just doesn't fit, and I will stand by my decision. Hey, looks like you're handling the pain just fine.

I have yet to see a legit 9 or 10 that didn't elicit some form of physical manifestation. I don't care how tolerant of pain you are, a 9 or 10 will show itself in your actions, every single time.

Finally! Someone who understands what I mean. I used to work with a medic (several in fact) that would dose every pt with fentenyl or morphine just because they had any pain, regardless of the pn level. You are obviously not one of them because you understand judgement and don't take your protocols from the billing department. Thank you!