Fentanyl with MI

[fiznat]

Nooooooooooo...... Don't tell me you're one of THOSE. . . . You'll be hard pressed to see morphine pushed in LA County for anything less than a femur fracture. Severe Abd pain, MI, non-femue long bone fractures, NOPE

No no, I'll definitely do what I can to control pain in most patients. I gave it for ABD pain twice this week, and I even had to call medcon to ask for it (we have to call if it's ABD), so I'm not lazy. ...I just don't think it's worth the time with ACS when I've got all kinds of other stuff to do and the drug has been falling out of favor for this condition anyways.

[firedoc5]

This is really the first time I've admitted it, but our protocols, as most back then...when adm. MS for chest pain it calls for 2-4mg. titrated to BP and pain relief. If it's an obvious MI, and the patient's pain is 8-9/10 and their BP is at least 120, I'd go ahead and pop them with 5mg. Because I know enroute I'd be giving him a total of at least 5mg. I did approach my PMD about this and he patted me on the shoulder and said that it was good thinking on my part and he didn't have a problem with it. He concurred that pain relief was my main priority. With what we had, that was the best we could do. His ECG was a sinus rhythm with no ectopy, so nothing to treat there. His BP was stable. So really, it was just the chest pain to treat.

He was flown out and had a triple by-pass within an hour of arrival in Springfield.

I don't know if anybody here would gasp at doing that, or would agree.

[ERDoc]

Persoanlly, I hate the 0-10 pain scale. It is so subjective as to be pretty much useless. I can't tell you how many times I seen someone with 10/10 abd pain who was sitting there on the strecher, laughing on the cell phone with obvious cheetosis. No, your pain is not 10/10. If you are able to sleep through the pain, it is not 10/10. Your number on the pain scale is not going to change my management. If you have pain, I will treat it. I will reassess your pain several times and if you are still having pain, you will get more medicine. All I need to know is is the pain better, worse, the same or gone. With enough experience, you begin to know who really has pain and who doesn't, you can tell who is overly dramatic and who has real pain. This is one area where experience is definitely better than education. A little rule of thumb I've learned here where I am (may not apply to your area) is the true amount of pain you are having is inversely proportionate to the amount and volume of your screaming as well as the number of family members that are hanging onto your neck screaming that we need to do something. Give a number like 12 or 20 you lose any respect because you cannot follow simple instructions, the scale onlly goes to 10. I'll get off my soap box now and end my rant with one llittle story.

I don't remember where I read this so I cannot give proper credit, but I once read a story about an ER doc who had a room with 2 patients in it. Behind the first curtain was a 19y/o male who had a small laceration on his finger that didn't even require sututes. He was screaming in pain that he needed something for his pain. The doctor then went to the next bed in the room and found an older gentleman who had cut his index finger off. The doctor asked him if he wanted anything for the pain and the gentleman said, "No thanks. It only hurts a little. I told the nurse a 2 or 3." The doctor then asked him if that was a 2 or 3, what was a 10. The gentleman replied, "Getting shot in the chest 5 times by the Germans is a 10." :wink:

[fiznat]

Thats another thing. Do you guys have MI patients who complain of agonizing pain? My experience has been that the true MI patients go as far as to correct me when I ask about their pain. "It's not a pain, really" they say, "It's more of a pressure." Even the really bad ones who look like crap- tombstones/hypotensive/cool/pale/diaphoretic/obviously having a MI aren't really in that much PAIN per-se. They complain of weakness, chest pressure, feeling "washed out," SOB, but never really pain. Not like my-arm-is-broke pain anyways.

Do you guys have different experiences?

[zzyzx]

Anthony wrote, "You'll be hard pressed to see morphine pushed in LA County for anything less than a femur fracture. Severe Abd pain, MI, non-femue long bone fractures, NOPE."

So LA County Fire is still like that? Sad. Seven years ago when I was just starting my field training as an EMT, I remember we transported a guy with a dislocated shoulder. County Fire just BLS'ed him and didn't give him any morphine. It was a long and bumpy ride to the ER, and this guy was tearfully crying the whole way. I thought things had changed since then.

[firedoc5]

Anthony wrote, "You'll be hard pressed to see morphine pushed in LA County for anything less than a femur fracture. Severe Abd pain, MI, non-femue long bone fractures, NOPE."

So LA County Fire is still like that? Sad. Seven years ago when I was just starting my field training as an EMT, I remember we transported a guy with a dislocated shoulder. County Fire just BLS'ed him and didn't give him any morphine. It was a long and bumpy ride to the ER, and this guy was tearfully crying the whole way. I thought things had changed since then.

I would have asked for Valium at least, try to relax those muscles and tendons. We had a 14 yr. old that was playing "wrestling" and he hyper-extended his knee to the point it was at a 90 degree angle. Luckily there just happened to be the best ortho in the ER with another pt. He got on the radio and told us to keep pushing Valium and MS. Once at the ER my partner and I helped the ortho to straighten it out. He said by giving those meds as early as possible made it a whole lot easier for him to reduce the hyperextension. But watching how he worked massaged and gradually straighten the leg. then "pop" it back into place made my butt pucker. Sounded like a .22 rifle going off.

Believe it or not, they wrapped it, put him on crutches and he walked out about two hours later.

Sorry, still not trying to hi-jack the topic. Just commenting on the previous posts.

[Dustdevil]

Unfortunately, I know there are those systems where everytime you call for MS orders, some A-hole doc denies you, so you eventually just stop wasting the time and dignity needed to even try anymore. Then, of course, the very same doc starts berating you for not treating the pain.

[spenac]

Unfortunately, I know there are those systems where everytime you call for MS orders, some A-hole doc denies you, so you eventually just stop wasting the time and dignity needed to even try anymore. Then, of course, the very same doc starts berating you for not treating the pain.

I am so glad I do not work for a mother may I system. That must suck to always call to do what needs doing.

[AnthonyM83]

I say 10 being the worst pain you have ever felt 1 being no pain.

I know a lot of books say it that way, but I hate the 1 being no pain part. I say 0 being no pain. Just makes more sense to have zero pain. Then if it's barely hurting anymore it can be a 1 or less. This also gives them a whole ten integers to rate it with and it makes five be in the middle of the scale.

(if you do 1-10, 5.5 is in the middle of the scale. Cause remember 10.0 is where you max out...you can't actually count the entire 10 number.... But i'm just being anal

[AnthonyM83]

That reasoning I'm good with