Kidney Stone Pain

[firedoc5]

Of course I've heard arguments back and forth on pain treatment for possible kidney stones. If the pt. has had a history of stones and knows exactly what it is, do you treat the pain in the field or not? MS and/ or Demerol is the standard meds. But I don't know how many carry Demerol. The severe flank pain, bloody urine all indicative of stones. But MRI and x-rays needed to confirm stones and not other kidney function problems. One argument is that stones need to be absolutely confirmed and you can't do that in the field prior to any meds. given.

So, what are your protocols or opinions? Pain management has been discussed here for trauma and cardiac. What about other situations?

[p3medic]

Pain should be managed for everyone when possible.

[GypsyMedic]

Definitely pain management should be administered, but in my area, we can't give anything for any abdominal pain. Archaic, but still the case.

I'd love to give up some Demerol for kidney stones, but we don't carry it. Only carry Morphine and our med director doesn't want Fentanyl. Anyone wanna talk him into it for us?

[paramedicmike]

Pain management when indicated. To withhold analgesia when you have the tools and ability to do something about it would be unethical.

I'd love to give up some Demerol for kidney stones, but we don't carry it. Only carry Morphine and our med director doesn't want Fentanyl. Anyone wanna talk him into it for us?

Why not gather the research (readily available over the internet) and talk to him yourself? You may be surprised at what happens.

-be safe

[firedoc5]

Another argument is for migraines. But you should be leary of pain med. seekers. That's one of the big issues discussed.

We had one guy claiming kidney stone pain. I was really feeling for the guy since I stopped counting at 12 stones myself. But later in the ER come to find out, he actually took a pebble and inserted it, you know where. He was a pain med seeker and was dumb enough to think stones were like, well, stones. He actually did this a few times later, even though he got caught. Some people never learn. At the time there was no way to arrest the idiot. But I guess if you are determined enough you'll try anything.

[akflightmedic]

Got anything against Ketoralac (toradol)?

At least its something...

[firedoc5]

Got anything against Ketoralac (toradol)?

At least its something...

Myself, I'm allergic to it. Makes me sicker than a dog, and if IM, the site swells and get red streaks. But from what I've been told it helps minimally.

[GypsyMedic]

Pain management when indicated. To withhold analgesia when you have the tools and ability to do something about it would be unethical.

Why not gather the research (readily available over the internet) and talk to him yourself? You may be surprised at what happens.

-be safe

We had a very large group discussion during rounds about two months ago when Fentanyl was brought into our system. Everyone else wants it, he just doesn't believe the benefits outweigh morphine.

Good advice, though. I will certainly do some research of my own and pass it on. Maybe he hasn't looked into it thoroughly enough, as well as anyone else in the discussion.

[firedoc5]

One thing to remember about MS is that it's a great diuretic and may help flush out a stone. I know my Urologist gives low dose MS along with higher dose Demerol in-house.

[Mateo_1387]

For known kidney stones, I do not think it is a problem to give pain meds. One place I work for specifies that persons with kidney stones are given Ketoralac, and if it does not work then a narcotic may be used. As far as the other agency I work for they are under the impression that abdominal/flank pain = no pain management.

I believe it was Doczilla who had a post that went into some detail about how narcotics should not cause a problem for a physicain to performing an assessment. If I remember it right he said there would be lab work done, physical exam, thorough history, and many other factors that will lead to the diagnosis. I am just thinking out loud, but if a medic used morphine to treat abdominal pain, and the doctor really wanted the patient to be in pain to perform a proper abdominal exam, then could he just use narcan to reverse the effects of morphine?