Pain Management, Multi-Systems Trauma

[Vorenus]

Would love to have Entonox - can`t see while we`re unable to make that step here.

It would be a useful addition to our trucks as well as to our competences (we could be allowed to give it and therefore reduce the calls for the emergency physician for analgesia in minmal to moderate cases, seeing that it has only minor side-effects and a really short half-life).

@systemet: From your experience: Is the combined use of Entonox and anti-emetics sensible in these cases of nausea, or would you rather switch to another drug if the pat. develops such symptoms?

[rock_shoes]

There, that was easy. Now, who wants an omlette?

Mmm. Can I have mine with some fresh moose meat?

[Kiwiology]

We have been carrying entonox for nearly forty years, its bloody brilliant stuff. But, entonox is a 50/50 mix of nitrous oxide and oxygen, the FDA won't allow them blended in a single cylinder in the US so you blokes tend not to carry it because you have to carry two seperate cylinders and attatch a mixing thingo.

Most of our emergency departments also have entonox so if needed we can swap the patient onto the hospital supply but if pain is significant the patient is likely to have recieved morphine anyway.

I haven't personally encountered any significant problems with nausea or vomiting.

We did trial methoxyflurane for a bit a couple years ago with a view to having it replace entonox but decided against it because it's really pretty shitty and stinks worse than fat albert when he hasn't taken a shower, but certian space-or-weight restricted situations here it is still carried e.g. Ambulance Rescue or the motorcycle or rapid response unit.

[DwayneEMTP]

Hmmmm....maybe I got it confused with something else.

What is the stuff that is delivered via what looks like a green whistle? Or a hokey, home made pot pipe. You pour the solution into a cotton wad and the patient breaths through it. It's good for about a half hour until it is fully inhaled/evaperated, and you just simply toss it out. No tanks, no hoses, just a little box such as you'd expect D50 to come in and a little plastic whistle...

Maybe ak/chbare can help me out here...

Dwayne

Edit. Found a pic in my old Afg files.

Edited September 27, 2011 by DwayneEMTP

[systemet]

Hmmmm....maybe I got it confused with something else.

What is the stuff that is delivered via what looks like a green whistle?

I think that's methoxyflurane? It's used a lot in NZ / AUS. Not approved in the US because of a risk of liver CA (I think - or maybe I'm confusing my anesthetics).

@systemet: From your experience: Is the combined use of Entonox and anti-emetics sensible in these cases of nausea, or would you rather switch to another drug if the pat. develops such symptoms?

My preference would be to switch to opiate + antiemetic if that occurs. Ultimately it's the patient's decision. The entonox is essentially self-administered. They hold the mask to their face, breath in as often as they want, and stop when they become somnolent and drop the mask, or when they can no longer tolerate the symptoms. If they want to continue using it despite the nausea, then they can.

As I said earlier, I rarely use it as a single agent. It's certainly superior to opiates in managing labour pain, providing it's providing adequate relief. But outside of that setting, it's either for a quick move to the ambulance, if care can be better provided there, or I'm using it with opiates.

Obvious caveat: Medical direction determines what treatment modalities are present, and how they should be used.

[Kiwiology]

Yeah that's methoxyflurane, it was used as a general anaesthetic in the 1960s but has since long been banned by the FDA because of its nephrotoxicity

While it's not banned here, Medsafe warn against its use in high doses and insist it is used in a well ventilated area - i.e. not the back of the ambulance lol

Locally methoxyflurane is only carried where space is an issue and preclusive to the transport of entonox - i.e. Ambulance Rescue (SERT), the motorcycle response unit, rapid response unit and some very rural stations where resupply of entonox is a problem

[rock_shoes]

Hmmmm....maybe I got it confused with something else.

What is the stuff that is delivered via what looks like a green whistle? Or a hokey, home made pot pipe. You pour the solution into a cotton wad and the patient breaths through it. It's good for about a half hour until it is fully inhaled/evaperated, and you just simply toss it out. No tanks, no hoses, just a little box such as you'd expect D50 to come in and a little plastic whistle...

Maybe ak/chbare can help me out here...

Dwayne

Edit. Found a pic in my old Afg files.

I was wondering if you might have had something else in mind. I didn't think they'd have you flying around Afghanistan with a compressed gas tank containing a 50:50 mix of oxygen/nitrous oxide. One tank of a powerful oxidizing agent on board is enough when you're potentially being shot at.

[chbare]

I also agree, the picture is of a methoxyflurane administration device. As stated, it's not used in the United States due to the problems with organ damage. I believe the green device is called a Penthrox inhaler.

[crotchitymedic1986]

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

[Just Plain Ruff]

didn't know this topic had turned from multisystem trauma to sickle cell. Are you trying to turn this conversation racist again by bringing up a disease that affects more blacks versus whites and by us not giving a specific drug we could be considered racist?

We carry morphine, and fentanyl and whichever works on Sickle cell pain is what we give. The patients usually tell us what had worked best inthe past morphine or fentanyl and we give it to them.