Vitals with pain.

[jroyster06]

Well, how about a standardized pain stimulus? My med school mentor looked at ED patients having an IV started, and tried to correlate their levels of pain and anxiety with VS. In his paper Heart rate response to intravenous catheter placement. he found that there was no such correlation. They concluded "These data illustrate that monitoring of a patient’s heart rate is not a reliable indicator of the amount of pain that he or she is experiencing. Making the assumption that a patient is not in significant pain because of a lack of tachycardia might lead erroneously to inadequate treatment of significant pain."

There are other studies out there, but this is the gist.

I wont say that i have ever wrote a paper on this but i have done the same thing. I have done this in the back of the truck using my monitor to watch HR. I have not seen any difference whatsoever during cannulation even when dropping the big mambo jambo 16g and 14g water hoses on trauma/reallllly sick people.

Doczilla, In my previous life (pre EMS as a welder out of highschool) I built the MRAP trucks out here in Sealy, TX. Those things a a truly well made product!!

 

[jroyster06]

This. Assessing patient's pain is a bit of an art form. You can't just rely on certain numbers or the patient saying 10/10. Things to consider-

Appearance- sweating, grimacing, guarding, fidgeting

Speech - are they able to talk to you? are they talking on the phone (lol)

Pain rating - 0-10/10 , mild, moderate or severe? are they comfortable? DO they want something for the pain?

Diagnosis- your own dx and ddx of what the problem may be including visible sings and symptoms, vitals

History- is the patient giving you vague symptoms? are they asking for certain drugs by name (lol) do they have frequent trips to hospital?

We SHOULD be treating pain in the pre-hospital environment. Using the above tools you should be able to work out the best METHOD of treating the pain.

For my service we have-

Splinting, position, elevation, cold pack, slinging
Paracetamol (tylenol)
Methoxyflurane (short acting inhaled analgesic
Morphine IV/IM
Fentanyl IN (children)

We can call for extra assistance-
Midazolam
Fentanyl IV/IM
Ketamine

Pain should be treated but it doesn't have to be Morphine for all pain, neither is P.O tylenol appropriate for severe pain. You can always work your way up. Fractured wrist? I'll try some methoxyflurane. If the patient is still complaining of pain/can't tolerate the smell/taste or won;t use it properly I might consider IV/IM Morphine. This is obviously after splinting etc.

My Thoughts exactly!

We carry
Morphine IV/IO
Fentanyl IN/IM/IV/IO
for pain management

We also have
Versed, valuim, Ativan And ketamine<----that drug is a life saver (LITERALLY)

 

[Baele11]

Since your partner doesn't seem to believe you, maybe he needs a more tangible lesson. Try this: Hook him up to a monitor and get a set of vitals, then hit him with a bat (try to break a rib or two), take his vitals, and get his pain scale, finally wait ten minutes get another set of vitals and check his pain level. I bet you his vitals will be elevated after you smack him and will have normalized after 10 minutes, his pain however will probably still be pretty high. That should settle the debate...

 

[johnrsemt]

Baele1 I like that idea; I know a few people that could be a good study on even if it wasn't for pain control: Just because