Pain Management, Multi-Systems Trauma

[rock_shoes]

what is your pain management protocol for sickle-cell patients, versus those with fractured extremities

I've never seen a pain management protocol specific to sickle-cell for EMS. I think it depends on the specific sickle-cell related pain complaint. Specifically in the case of an acute priapism a subcutaneous injection of terbutaline would be appropriate in conjunction with standard gerneral pain management (morphine, fentanyl, etc.). Refractory to administration of alpha adrenergic agonists additional treatments for priapism include intrapenile injection of vasodilators and needle aspiration of the corpora cavernosa.

Or were you just being facetious?

Edited September 27, 2011 by rock_shoes

[Bieber]

what is your pain management protocol for sickle-cell patients, versus those with fractured extremities

We don't have a specific protocol for patients complaining of pain with sickle-cell disease. I'd probably call for orders for fluid and fentanyl as needed to control their pain.

[Kiwiology]

Interesting, our pain management guideline says (and I quote)

- Entonox for "mild to moderate pain"

- Morphine for "moderate to severe pain"

- Ketamine for "moderate to severe pain, particularly musculoskeletal or burn pain"

The source of the pain is irrelevant

[ERDoc]

Agreed, Kiwi. Pain is pain. It doesn't matter what the cause is, you should do what you can to treat it. The cause may change the gameplan, but it shouldn't change the goal.

EDIT: We currently have 3 or 4 threads that have been turned into race discussions. Let's not let the local troll take another one down that road.

Edited September 28, 2011 by ERDoc

[WelshMedic]

Hi all,

I realise that I'm a little late on weighing into this discussion but I wanted to tell you about my experiences with ketamine. My opening line: it is simply the best thing that has happened to pre-hospital care in 10 years.

Ketamine has been around since the 60's. It is a disassociative anaesthetic which means that it shuts the brain off to conscious experiences. You take a pt. literally writhing in pain from, let's say, a long-bone fracture and medicate them. The first thing they then remember is waking up at the ER. It's only real disadvantage is the re-emergence phenonmenon, which plays a part when the pt. is waking. It can be best described as intense nightmares and some people can wake up literally screaming. It's not all bad news though. Re-emergence can be effictively managed by co-commitant doses of benzodiazepines. My personal choice is midazolam, I find that it very effective in combatting re-emergence. To the extent, in fact, that I have not seen the phenomenon for at least 4 or 5 years.

It's obvious advantage is that it has no negative effect on hemodynamics. Whilst it can lead to a positive intotropic effect, it is very transient. I have never encountered a problem in the 10 years I have been using it.

Ketamine is safe, very effective and versatile. I would recommend that your service consider it as an option, your patients derserve it.

WM

[DwayneEMTP]

Man...I really, really want to take Ketamine for a test drive. I've never used it..

Dwayne

[akflightmedic]

Man...I really, really want to take Ketamine for a test drive. I've never used it..

Dwayne

I stock it...just sayin...

(In case you ever decide to come back my way)

[DwayneEMTP]

Heh...you know I wanna!

Pretty sweet gig and schedule here brother. I miss working with you though, so don't let me drop off of the radar...

Dwayne

[Kiwiology]

If you want to try ketamine, stop by the local rave or dance club and ask the glossy eyed teenagers

[BushyFromOz]

Interesting how many people have missed the point that providing adequate pain management is about providing humane management. To not provide through lack of equipment, skill set or protocol is inhumane at best and negligent at worst

Pain is pain

Just sayin

As for the K-juice, we trialled it here and it was an astounding drug. The stand out demo for me was a patient partialy ejected in a car v's tree, ended up with her mangled legs mashed in amongst the front drivers side suspension / sterring arms screaming her head off

Special K sorted her out real good.