What pain management options do you have?

Fox800 said:
Our only medication option is IV/IN/IM fentanyl. Morphine was taken away about 2 years ago. Midazolam and diazepam were under a "pain/anxiety" management guideline but with our latest clinical guideline revision they are no longer approved for that use (which is unfortunate).
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Why was midaz taken out?

Brown is not really a fan of the "midaz people into orbit" trick because midaz is not an analgesic and just because the patient may not remember does not mean they are not still in pain. Physical sensation of pain and physiologic response to pain are two different things and both need to be considered.

Thats why Brown likes having ketamine avaliable :D
 
MrBrown said:
Why was midaz taken out?

Brown is not really a fan of the "midaz people into orbit" trick because midaz is not an analgesic and just because the patient may not remember does not mean they are not still in pain. Physical sensation of pain and physiologic response to pain are two different things and both need to be considered.

Thats why Brown likes having ketamine avaliable :D
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I'm assuming it was removed because some providers were going overboard with the opiates + benzos combo.

Straight from the horse's mouth:

"Anxiolysis in the setting of pain is resolved by removing the pain. Catacholamine stimulation and the subsequent anxiety is a normal physiologic response to pain. Treating the pain is treating the source rather than the symptom. The combination of narcotic pain relief and a sedative agent is conscious(procedural)sedation. This greatly increases the likelihood of respiratory suppression."
 
I don't give Versed for anxiety/sedation. It is used as a skeletal muscle relaxant in certain dislocations and fractures. It is a very fine distinction, but one our doc recgonizes, especially if you dose appropriately. It is amazing how much help just .5 of versed can do.
 
Aidey said:
I don't give Versed for anxiety/sedation. It is used as a skeletal muscle relaxant in certain dislocations and fractures. It is a very fine distinction, but one our doc recgonizes, especially if you dose appropriately. It is amazing how much help just .5 of versed can do.
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I've heard a bit about this idea and I'm quite interested to hear more.

We can drive truck loads of midaz into an uncooperative pt but I get the feeling we'd get hauled over the coals if we went near a fracture or dislocation.

Is midaz in any of your guidelines for this purpose?
 
Melclin said:
I've heard a bit about this idea and I'm quite interested to hear more.

We can drive truck loads of midaz into an uncooperative pt but I get the feeling we'd get hauled over the coals if we went near a fracture or dislocation.

Is midaz in any of your guidelines for this purpose?
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We had kind of a blurred line. Diazepam was approved for muscle spasms/anxiety, but midazolam was also approved for anxiety.
It was part of a catch-all "pain/anxiety management guideline" that had fentanyl, diazepam, and midazolam as options.

Our "violent patient guideline" featured midazolam exclusively.
 
we have versed for anxiety/agitated Pt

agitation/combative: 1mg IV Q 2min PRN up to 5mg, or 0.1mg IM max of 5mg.

anxiety: 2mg IV repeate 1mg every 2 min PRN up to 5mg

pain: morphine 10mg prior to contact
 
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