Should you withhold Pain Meds if close to hospital?

[brentoli]

Here is a doctor that doesn't withhold pain medication. Semi off topic. http://shar.es/1IaeE

96,000 scripts in 3 1/2 years. Another paper did that math and it came out to 1.04 prescriptions per minute of the workday.

[HellsBells]

In our urban service, a lot of our transports are less than 10 min, if anyone followed this nurse's policy, a great deal of our pts would not receive analgesic. I think that the nurse in question just has an axe to grind, and wouldn't pay her much mind.

Our service has Morphine, Fentanyl, and Versed for pain control. The problem is our protocols state we have to give morphine first, fentayl if, and only if the pt has an allergy to morphine, and versed, only after the pt has received 20mg of morphine without pain relief. Fentanyl is mainly used along with Versed and paralytics for our RSI.

[AnthonyM83]

Just skimmed through this thread, but I'd recommend reading through the many journal articles explaining that pain meds don't usually hinder assessment and a number of articles actually stating they help the assessment. If she gripes about it again, you can have a conversation about said articles and how it's a common standard of care now. You might also ask around at other hospitals in the area and see if they agree (which would help prove your case to her, that it's a standard).

[ERDoc]

That has made it bad for us because helicopters can not reach us many times so we used to have them meet us at the hospital and give them to helicopter crew to take to a bigger hospital. Now we have to find landing areas elsewhere or have the band aid hospital add to the patients bill and also delaying the care they need.

I just noticed that someone has said you should with hold pain meds on both poll options. Care to explain?

I work at a hospital that has a helipad that is often used as a landing site. The way it has been explained to me is that EMTALA does not affect the hospital because the pt is requesting the serices of the trauma center that they are being tranferred to, but have not requested the services of our hospital. Because they have not requested our services, EMTALA does not go in to effect. That being said, I do not know where this decision came from (lawyer, someone's brother's cousin's best friend's uncle, etc) and it has not been tested in a court case yet. I will look into a little more and let you know if I find anything.

[WTEngel]

My old medical director used to say "There is no higher calling than to save another man's life, or to TAKE AWAY HIS PAIN'

I believe this is true. Now, taking into account that a doctor normally does want to assess a patient's pain, I would advise against snowing your patient. You typically aren't going to administer so much medication as to mask the pain entirely.

I for one can't stand to see someone in pain, and approach it from the perspective of "If that was my mother...."

In addition to that...pain meds may be a long time coming after you drop the patient off at the ER, considering Nurse Ratchet has to receive her physician's order, get said narcotic, find a co signer, etc etc... I say take the edge away, and let the patient thank you. As long as you don't snow them and you stick to the protocol, then no one can fault you...

Treat the treatable, take away the pain, and above all else, do no harm.

[ERDoc]

I know there is a big push from many different directions to reduce on scene time. But in a non-life threatening situation, what is the problem with a longer scene time if you can relieve some pain. As for the drug seekers, when you do the job long enough you get a pretty accurate BS meter. Someone mentioned vitals as a way to tell if someone was really in pain, but there have been studies which show that vitals are not an accurate predictor of true pain. Personally, I would prefer if a migraine pt not get narcotics in the field (I almost never use them in the ER). They are one of the worst meds to give for migraines because they can cause a rebound headache, which is worse than the first. There are much better treatment options, which you most likely carry in the field.

[mobey]

I know there is a big push from many different directions to reduce on scene time. But in a non-life threatening situation, what is the problem with a longer scene time if you can relieve some pain. As for the drug seekers, when you do the job long enough you get a pretty accurate BS meter. Someone mentioned vitals as a way to tell if someone was really in pain, but there have been studies which show that vitals are not an accurate predictor of true pain. Personally, I would prefer if a migraine pt not get narcotics in the field (I almost never use them in the ER). They are one of the worst meds to give for migraines because they can cause a rebound headache, which is worse than the first. There are much better treatment options, which you most likely carry in the field.

Ya, the narcotics for migrane is a no-no around these parts too.

I believe most services will give Maxeran, although it is off label, and you may have to note that you gave it for the vomiting that accompanies a migrane.

[kevkei]

Ya, the narcotics for migrane is a no-no around these parts too.

I believe most services will give Maxeran, although it is off label, and you may have to note that you gave it for the vomiting that accompanies a migrane.

Yes to the Maxeran (metoclopromide), with Acetaminophen P.O. Maxeran treats the nausea but also increases the bioavailability of the Acetaminophen and has a synergistic effect.