Kidney Stone Pain

[ERDoc]

Personally I don't like to use narcotics for kidney stone pain. I like to use IM or IV Toradol with Phenergan.

The literature shows you are doing your pt a disservice. Toradol and a narcotic have been shown to provide better pain relief.

[Ridryder 911]

Personally, I start out with Toradol & Phenegran IV, then use Morphine. Most renal calculi have severe pain and associated nausea. My opinion is either Toradol will work or not, not an in between drug.

R/r 911

[DwayneEMTP]

When I precepted in the Springs we had many of these cases for some reason, or perhaps they're common everywhere....

When we had the common flank pain, bloody urine or not, we gave fentanyl, almost always 100 mcg if I could possibly justify it. (Protocol is 1mcg/kg (.5/peds/geriatrics) to max 100mcg without calling the doc. We would simply be terrible judges of weight when necessary.) We treated all 'stone' like abdominal pain immediately, or you'd have to answer to the doc later.

Of course they would almost always immediately give morphine at the hospital...

As for migraines...I'm allergic to everything but Dilaudid, and resistant to that, so my doctor always gives me....well...you know. :wink:

Dwayne

[Oscar]

Got anything against Ketoralac (toradol)?

At least its something...

I had a kidney stone in 1995 (remember it vividly) :shock:

Looking back, I wonder if the ED folks thought I was a seeker - all I got there was an x-ray (confirming the stone) and saline IV. I didn't receive any pain meds until about 48 hours into my ordeal and that was from my PCP.

Morphine and Demerol had no effect on the pain, other than to knock me out for a few minutes. When I was given Toradol, the relief was immediate and lasted until I passed that little bugger.

In the unfortunate event I were to ever have another kidney stone, I will be yammering for Toradol immediately.

[akflightmedic]

I didn't receive any pain meds until about 48 hours into my ordeal and that was from my PCP.

Wow! You are hardcore!

You took PCP for your own pain management??

[Oscar]

Wow! You are hardcore!

You took PCP for your own pain management??

Whadda mean - hardcore? The protocol was endorsed by High Times magazine! :wink:

[firedoc5]

Since when did morphine cause diuresis?? If anything it has just the opposite affect and causes increased ADH production.

From day one of pharmacology classes, chest pain with potential CHF requires MS for pain and as a diuretic for the excess fluid. I know it works for me.

When it comes to kidney stones and migraines, I guess I'm a difficult case. In a previous post I mentioned what Torodol does to me. Phenergan makes me hallucinate, Compazine causes head-to-toe severe muscle spasms. So it's usually Demerol and Visteral IM. I've seen the same thing in a few others. I've had some others that helped but not as well as Demerol.

[AZCEP]

[From day one of pharmacology classes, chest pain with potential CHF requires MS for pain and as a diuretic for the excess fluid. I know it works for me.

Need to look at that a bit closer firedoc5. Morphine is not a diuretic, and you are not using it as one. That is an entirely separate discussion.

[firedoc5]

Need to look at that a bit closer firedoc5. Morphine is not a diuretic, and you are not using it as one. That is an entirely separate discussion.

Yeah, you might be right. I know I've got my old notes around somewhere. Maybe it was that you could use as one. I'm not as think as you confused I am.

[Dustdevil]

LOL@PCP for a kidney stone That's beauty!

But yeah, back in medic school, the discussion of using MS for CHF and PE does often leave the student with a lasting belief that MS has significant duretic actions. This isn't the first time I have heard that belief. This is probably something that schools should make a concerted effort to clarify the issue as they teach, taking care to not closely link morphine with furosemide in pharmacological discussions.