Pain relief and EMS

[Quakefire]

No this was in hospital, for a pt. who's anti-psycotic drugs turned on him and rotted out his brain. Parkinsons like symptoms, decreased LOC and a fever. The acetaminophen was crushed and mixed with jam to facilitate swallowing

[rock_shoes]

I don't believe Paracetamol (Acetaminophen) is available in North America in intravenous form.

It is available. I've seen it used by our service's Infant Transport Team paramedics (think advanced life support specifically for expectant mothers and pediatrics) a few times for fever control. I don't think it's very common in any other arena.

[Richard B the EMT]

The acetaminophen was crushed and mixed with jam to facilitate swallowing

Those who are unable to swallow pills or tablets, if the med is in a hard form, that pill can be crushed and mixed into something else for easy ingestion. Jam? I'm used to hearing applesauce, but, whatever works.

However, that does not make it a liquid form, just a suspension in the applesauce or jam. Yes, I am arguing semantics, however, I have a feeling numerous meds can be obtained in a liquid form, both prescription and over the counter.

A suspension is not for intravenous. I have no information on acetaminophen in form for injection or infusion.

[WelshMedic]

Google Perfalgan and you'll find it all....(in Dutch )

[Novisen]

We have:

Diazepam

Midasolam

Propofol

Ketobemidon

Morphine

Paracetamol

Ketamine

Entonox

Diklofenac

We dont have to call for order. When I have an ICU patient we also have Alfentayl an Fentanyl. I work in Sweden.

[WelshMedic]

Thanks, Novisen, for your input here.

From the name I 'm guessing you are somewhere in northern europe, right? I'm from Holland and so I know we don't differ that much when it comes to ALS. I'd like some propofol, though.

WM

[Novisen]

The system in Sweden, Australia and Holland are very similar to each other when it comes to training and protocols I think. You have to be a nurse (3 years)+ 1 year of prehospital training before you can work prehospital. I work as an anhestestic nurse and in ambulance and it´s common that ambulance personel work like this. Halftime in the ER, IC or the OR

[WelshMedic]

Well, I think it's safe to say that Holland and Sweden are very similar. Here we are RN's with a post graduate critical care qualification and a year's training in prehospital care.

I think Australia has more in common with the Uk though, ALS providers that are university educated, but not necessarily RN's.

WM

[wrenEMT]

There wasn't this option so I put BLS provider with pain relief. Only reason I put that is because there wasn't the option of ALS provider with pain relief.

I will say one thing I have sympathy for those in pain but there are some instances that the people are either faking or it's a pain that you can't give relief to. ABD pain being one main one. I did have one medic tell me that since in our protocols it says that any pain rated over a 3 you can give up to 100 mcg of Fentanyl. I said well wouldn't that defeat the purpose of being taught over and over again in medic class you don't give pain meds to abd pain because it can mask what is really going on in the expansive space that is the belly? he said since the half life of Fentanyl is only 30 min it's ok to give since the patient doesn't normally see a doc for more than that in an ER. But I interjected again with. If in a severe case you might be sent to a shock/trauma room which gets a doc in there in approx 10 min. So you just masked the pain that could help dx what is really going on in your patient. No answer

I believe if you have pain meds use with discretion because there are those that will fake with the best of them to get what they want and if you think you patient is really in that much pain then go for it. There is no point in making them suffer

There is also my partner's philosophy.. Now that we have pain relief we shouldn't always use it.. mind you he has been in EMS for 25 years when everytime you wanted to give pain meds you had to call medical control and ask.. and most of the time you were denied.. it sucked but that is now his philosophy even now that he can give pain meds he doesn't always see the reason.. maybe it's because for so long he couldn't he doesn't think about giving them either. pain meds have their ups and downs.. and some that have been around since the beginning of EMS will tell you that they didn't always have the chance to give them so they don't now.

[WolfmanHarris]

I will say one thing I have sympathy for those in pain but there are some instances that the people are either faking or it's a pain that you can't give relief to. ABD pain being one main one. I did have one medic tell me that since in our protocols it says that any pain rated over a 3 you can give up to 100 mcg of Fentanyl. I said well wouldn't that defeat the purpose of being taught over and over again in medic class you don't give pain meds to abd pain because it can mask what is really going on in the expansive space that is the belly? he said since the half life of Fentanyl is only 30 min it's ok to give since the patient doesn't normally see a doc for more than that in an ER. But I interjected again with. If in a severe case you might be sent to a shock/trauma room which gets a doc in there in approx 10 min. So you just masked the pain that could help dx what is really going on in your patient. No answer

The abdo pain example reminded me of something I heard recently while listening to the podcast of the Merck Manual of Patient Symptoms on Abdominal pain. (not the most scholarly source, nor particularly easy to reference I know) In it, their speaker a Dr. Robert Porter (whose credentials on the Merck site are listed as "Clinical Assistant Professor, Department of Emergency

Medicine, Jefferson Medical College") states that (paraphrased):

While it was once thought that pain medication would mask abdominal signs, and some clinicians may still feel this way, that it seems clear that moderate doses of IV analgesic (50-100mcg fentanyl or 4-6mg Morphine) do not hide paretineal signs. In fact the decreased anxiety and discomfort in the patient may make examination easier.

I listened to this section of the podcast again just to be sure since I can't post the exact source. Anyone have anything more credible to back this up or even protocols that allow for pain meds in cases of abdominal pain?