What pain management options do you have?

[Outbac1]

For pain: Morpine up to 15mg, maybe more if we call and ask nicely.
For sedation: Versed up to 10mg.

We also have Diazepam (Valium) for seizures and Diphenhydranate (Gravol) for N&V. I wish we had Fentynal and Toradol as well. Not everyone can have morphine and it doesn't always work.

 

[dmiracco]

Paintball,

I no longer work in NM, Im in TX but thanks for noticing. I just havent changed my profile thingy. :blink:

 

[Flight-LP]

I have to ask, what service in NM used Nitrous? Or Ketamine for that matter? I'm just curious, since I've never heard any of the flight medics I know for SW or TSCF say anythign about those.

Native Air (formerly known as SWME / Omniflight) carries Ketamine. It was added last year when the CPG's were revised.

 

[TransportJockey]

Native Air (formerly known as SWME / Omniflight) carries Ketamine. It was added last year when the CPG's were revised.

Cool thanks its been a while since I dealt with flight teams on a regular basis. I used to see fixed wing PHI and SWME crews on a very regular basis since I ran the BLS night truck at my old service.

 

[TransportJockey]

Paintball,

I no longer work in NM, Im in TX but thanks for noticing. I just havent changed my profile thingy. :blink:

No problem I usually smile when I see other NM providers on here since they don't tend to hang around. Although I'm another NM EMT that's most likely going to TX, so I shouldn't say anything

 

[dmiracco]

Lol the only way a NM 911 service could obtaion those medications would be for that service to do a special skill application through the state and thats ALOT of work. I have done that for AMR in Dona Ana county for cardizem.

 

[johnrsemt]

Fentanyl
Morphine
Demerol
Versed

 

[medic417]

My drug bags bigger than all of yours combined. :lol:

 

[jjesusfreak01]

My drug bags bigger than all of yours combined. :lol:

I bought a Pyxis for my truck.

 

[46Young]

I bought a Pyxis for my truck.

I bought some shares in a broad pharmaceutical fund. I technically own a piece of everything, including al the meds in your pyxis.

 

[Melbourne MICA]

Options

Analgesia//

Morphine IV/IM PRN (no specific limit)
Fentanyl IN/IV 200mcg IN 1st dose 25-50mcg increments IV
Ketamine IV (severe orthpaedic pain only eg long bone fractures)
Methoxyflourane inhaled 2 x3ml doses max

Sedation//

Midazolam and Fentanyl (inductions)
Midazolam and Morphine (sedation infusion post inductions/intubations)
Midazolam (agitated pt)

MM

 

[BLSBoy]

Career Fire/Transport in Fla;
Fent, 100mcg loading dose, 50mcg q5 min up to 250mcg
Morphine, 2mg, q5 min up to 10mg
Nitrous is pt administered.

All meds can be upped with contact with medical control.

Career EMS/MICU in South Jersey;
Fent; whatever the doc says.
Morphine; whatever the doc says.

Some docs were aggressive. Some hated us. And God help you if you can't make contact with medical control and need to give pain meds or any other controlled substances. If you survive the initial ZOMG YOU GAVE MEDS WITHOUT PERMISSION?!?!, the paperwork you are buried in will take a tour to complete.

I like Fla. :wub:

 

[TraprMike]

We knock them out by hitting their head with a stone.

TRUE STORY: several years ago, my oldest son had a very bad tooth ache. he was like 10 at the time. it was just before closing time at the dentist office. the Dr. told me to give him a shot of whiskey every couple hours and come in, in the morning....

wish i would of recorded that convo...

 

[usalsfyre]

Analgesia//
Fentanyl IN/IV 200mcg IN 1st dose 25-50mcg increments IV

Question, because I've been playing with IN Fentanyl quite a bit here lately and the AUS and NZ providers seem to be the experts on it.

Does the higher inital dose provide supperior relief via the IN route? Our guidelines call for the same dose (1-2mcg/kg) no matter the route, so I've usually been going with 75% or so of the first dose IN with the remainder of the 1st dose IV once I can get them in position which an IV start is convinent for everyone. Should I be hitting them with higher doses right off the bat?

 

[Emtpbill]

Morphine: 2-4mg up to 20mg without calling.
Fentanyl: 25mcg, up to 200 mcg without calling.
Ketorolac: 50mg for kidney stones.

We also carry Valium, Versed and Ativan for sedation and/or anxiety, as well as Droperidiol, Phenergan, Zofran and Diphenhydramine, which we may use as an antiemetic or sedation as we see fit.

Droperidol ? We used to carry that but I thought it wasn't approved for prehospital use anymore because of prolonging Q-T.

 

[Flight-LP]

Droperidol ? We used to carry that but I thought it wasn't approved for prehospital use anymore because of prolonging Q-T.

While there was a FDA black box warning, Droperidol is still quite popular. There is a concern about Q-T prolongation, but many (myself included) believe the initial concerns were dramatically overexaggerated.

 

[Melclin]

Question, because I've been playing with IN Fentanyl quite a bit here lately and the AUS and NZ providers seem to be the experts on it.

Does the higher inital dose provide supperior relief via the IN route? Our guidelines call for the same dose (1-2mcg/kg) no matter the route, so I've usually been going with 75% or so of the first dose IN with the remainder of the 1st dose IV once I can get them in position which an IV start is convinent for everyone. Should I be hitting them with higher doses right off the bat?

The higher dose as I understand it is due to limited absorption. IN isn't equivalent to IV, which makes sense I spose. One of its bigger advantages is added pain relief for kids whom we cannot cannulate at the basic level here.

For reference the complete guideline is:
Adult (>14yrs): (>60kg AND age <60yrs); 200mcg, 4x 50mcg q5. (<60kg and/or age >60yrs); 100mcg, 2x 50mcg q5.
Paeds: 2mcg/kg, 2x 1mcg/kg q5.

With consideration to active asthma, the possible deleterious affects of combining it with amiodarone for our MICA chaps, elderly patients, pts with renal or hepatic impairment, COPD and combination with MAOIs.

The studies that validated IN fent used smaller doses (still above 2mcg/kg for adults) and it was regularly not enough. So I would say it would be better to consider bigger initial doses, within protocol and reason of course, etc. I feel our max doses are still on the conservative side for kids esp. But we shall see what I feel once I get out there using it regularly. It is encouraged that IN doses be followed up with prompt IV morphine with obvious consideration to combining the effects. MelbMICA will be far more useful to you in that regard.

It seems to work better in some pts than others. Anecdotaly, I've seen it work faster and with more reliable analgesia in younger pts. It seems to be a bit unpredictable in older people. A few other people have agreed with that observation, but its just based on opinion as far as I know, so take it or leave it. I've got the references to just about all the IN fent research ever done, so shoot me a PM if you want the list.

Like IN naloxone, there's a bit of an issue with concentration. You've got to have a high concentration drug prep otherwise you end up squirting litres of fluid up their nose. For the IN route, we carry 900mcg/3ml vials. What presentation of fent are you using?

 

[usalsfyre]

250mcg in 5ml is the sole concentration we carry. So that ends up with a 100mcg dose being 2ml, I usually split it 1ml a nare. I have found there is a certain amount of technique to getting maximum atimozation (and thereby absorption) with the MAD devices.

My general routine has been 75-100mcg IN, move the patient, start the line, then follow up with 50-75mcg IV. I haven't had a problem with oversedation yet, but find the IV dose is needed to maintain and/or achieve adaquate pain control.

Andectolally, I'll agree with the assertion it works better in the young. I've seen much better absoption on these patients as well, a few of the elderly patients I've used it on have been unable to coordinate their breathing with the administration and have ended up with half the meds dripping out of their nose. I do wonder if it has something to don with mucosal changes as we get older.

 

[firecoins]

TRUE STORY: several years ago, my oldest son had a very bad tooth ache. he was like 10 at the time. it was just before closing time at the dentist office. the Dr. told me to give him a shot of whiskey every couple hours and come in, in the morning....

wish i would of recorded that convo...

we can use scotch but not whiskey.

 

[YoungMedic]

Morphine
Versed
Ativan
Valium
Zofran

Consious sedation and RSI (Got to be 2yr medic for RSI)
Would like to see Fentanly in our box.