Should you withhold Pain Meds if close to hospital?

[spenac]

Hey thanks ERDoc and Aussieaid ... added to my files, and thank god I don't have to patch to use narcs .. and that so sucks HERBIE1 !

wallet biopsied tee hee.

I agree would hate to have to call for permission.

[Jwade]

This nurse obviously has no idea what she is talking about. The literature shows that giving pain medication does not interfere with the exam, in fact it has been shown to improve the accuracy of the exam. Even if you are in the hospital bay, give pain meds. In the time it takes for the pt to get into the hospital, onto the hospital strecher, triaged, wallet biopsied, etc, more meds will have had time to work. I'd recommend keeping a file of studies on the ambulance to show to hospital staff that have no idea what they are talking about. Here are a few to get you started.

http://www.ncbi.nlm.nih.gov/pubmed/17636812?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=3&log$=relatedreviews&logdbfrom=pubmed

http://www.ncbi.nlm.nih.gov/pubmed/17032990?ordinalpos=11&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1070812

That should be enough to get you started. Spenac, I'd make it a point to make sure this nurse got copies of these (as well as the doctor if he/she did in fact complain).

Excellent articles for people to keep with them in the rig or helicopter for sure.....No pain management for these patients was very prevalent in the 70's - 90's, however with the advancement of technology and 64 slice CT scanners, there is absolutely NO reason to withhold pain meds.....I have no doubt some attorney could make a strong case for negligence or malpractice.

Having spent 8 years as a First Assistant in Trauma Surgery in Detroit, I can categorically say, none of the Trauma Surgeons would ever hold pain meds so they could " Examine" the patient properly.....

Respectfully,

JW

[Lone Star]

Having spent 8 years as a First Assistant in Trauma Surgery in Detroit, I can categorically say, none of the Trauma Surgeons would ever hold pain meds so they could " Examine" the patient properly.....

Respectfully,

JW

Which hospital(s) and when?

[Jwade]

Which hospital(s) and when?

Hey, I started initially working in the O.R. at Hutzel Hospital, and then transfered to the legendary Level 1 Detroit Receiving Hospital. I was there from 1996 -2004.

I also worked contingent at a few other hospitals in the area as well, Henry Ford, Bon Secours, and St.Joes West.

JW

[kohlerrf]

So I used more pain meds on my patients last month than any of our other Paramedics. But as primary job is within 10 minutes to the hospital the director of nurses and me had a not so polite discussion about me interfering with doctors assessments of patients because I do pain management. The nurse said unless more than 15 minutes out I should not give pain meds. I told her my patients health and comfort come first not the doctors convenience and that any doctor that knows their job can still properly assess a patient that has been given pain meds. Plus if it seems to be hindering they can reverse the affects. So was I wrong? Would you withhold pain management?

Also I am fully in compliance with my medical directors pain management guidelines, so this is not me being a rogue medic.

Pain Hurts ! Stop the Hurt !

[crotchitymedic1986]

I am sure someone has already stated this somewhere, but if not, we also have to realize that many EMS agencies are very limited in pain medicine that they carry. I am all for pain management, but that should include using the right drug. Morphine, Demerol, and Valium are usually all that is available; most services do not include Toradol, Versed, Fentanyl, or other alternatives. So you might want to see if your agency can use a drug that is more short-acting. If you continue to be the Paramedic who doles out the most narcs, you will be the Paramedic who gets the first pee test -- not sayin it is fair, just reality.

[Just Plain Ruff]

I am sure someone has already stated this somewhere, but if not, we also have to realize that many EMS agencies are very limited in pain medicine that they carry. I am all for pain management, but that should include using the right drug. Morphine, Demerol, and Valium are usually all that is available; most services do not include Toradol, Versed, Fentanyl, or other alternatives. So you might want to see if your agency can use a drug that is more short-acting. If you continue to be the Paramedic who doles out the most narcs, you will be the Paramedic who gets the first pee test -- not sayin it is fair, just reality.

Spoken like someone who speaks from experience

All true what Crotch says

our service carries

morphine

fentanyl

toradol

acetaminophen

motrin

valium

versed

If fentanyl doesn't work - morphine does and usually vice versa.

I have a friend who works for a service and they don't carry narcs due to mismanagement of those said narcs in the past. Sucks to be in pain in their system. They just got narcs after a 5 year absence.

[EmergencyMedicalTigger]

So what are you supposed to do if you have a patient screaming in pain with a dislocated knee, and you're only 2 miles from the hospital?? Sorry sir, we're so close to the hospital, you're just gonna have to suck it up. Whatever. The MD is an idiot. Do what's best for your paitents.

[crotchitymedic1986]

The answer is you treat them no matter how far you are from hospital, but you use the appropriate med. Fentanyl is very short acting, but works great, it is the perfect drug for your scenario. It knocks down the pain, but they are fairly alert 15-20 minutes later, when the Doc sees them. The Nurse was wrong, as LOC doesnt matter for an isolated extremity fracture. LOC is important in the multi-trauma patient where a head injury is possible (but they will get a CT either way, so maybe not).

My point is that if you are giving Morphine for every patient that has pain, then that is a disservice to those patients. They should be treated with the appropriate drug. I say the same thing for Paragods that use Versed for RSI, it is the wrong drug for the scenario -- you should not overdose someone so that you can put in an ETT. If you are going to do RSI, use paralytics.

Now the spinoff question, who are you, and who are you not managing pain for ? Are you medicating all sickle cell patients who claim to be in crisis ? Are you medicating your drug-seekers who are screaming in pain, but have absolutely normal vital signs ? How about severe abdominal pain ? Migraines ? Fractured finger/toe ?

[spenac]

I treat the patients based on whats going on (s/s's). We have numerous choices so I can choose based on time to definitive care which may not be my hospital, type of injury, illness, etc. I use versed or other for sedation in combination with one of the choices of paralytics, based on patient event, HX, etc.

What types of patients? Race plays no part. Their past medical HX does play a part and while I know certain illnesses happen more in certain races I never presume that just because they are a race they have that problem as it could cause me to miss the actual problem.

As to drug seekers. Not my job to decide who is faking.

I don't push enough narcotics to worry about being considered a user, as mentioned earlier we are rural and most of you guys push more in a week than my entire service does in a month probably. Plus as far as Pee test I used to think my name was random.