giving Narcotics like candy

[canuckemtp]

Hey everyone:

I was on a call this AM where a 71y/o lady had fallen 3 days ago and she had severe pain in her legs, arms, and chest wall. we could not move her so I gave her morphine (as per our protocol) this helped, we got her out. So I gave report and the doc was there. When I said I gave Morphine he said we give narcotics way too much. when it is not needed. We could not even move her an inch with out her screaming in pain. I thought it was warranted what do you all think?????

Canuck EMTP

[nsmedic393]

As long as you were acting within your scope/protocols and in the patients best interest then you did the right thing. It sounds like the doc may have been making a general comment, not an actual attack on what you did. I know that there are medics out there that do give drugs just because they can or because it makes them feel/look important. As long as you aren't one of those people than I would just let the comment slide as it doesn't pertain to you.

[Nate]

To be honest, I can't really say what I would do if I was in your position. As long as you were following protocol, you have nothing to worry about. I agree with the statement above that it doesn't sound like the doctor was attacking you.

[Dustdevil]

A lot of docs make asinine, off-the-wall statements like that during patient presentations, instead of shutting up and listening like they should be doing. And I can't count the number of times docs have smarted off to me about the use if narcotics in the field. Don't worry about it. When it is his mother lying on the bathroom floor in pain, he'll suddenly have a whole new perspective.

Unfortunately, our idiotic "war on drugs" mentality in this country has created a popular culture within the medical community which places "just say no" over the care and comfort of their patients, and it's retarded. Fortunately, there is also a counter-movement within the medical community which is gaining in popularity which advocates compassionate pain management. The science is on their side. They just have to overcome all the hard-heads with the archaic attitudes.

[Nate]

I think the problem with pain control is that it is the one vital sign that can't be truly measured; which makes abuse easy. If you work in the urban setting where drug seeking is common; it becomes hard to tell those who fake from those who have pain when it is obvious.

[KEMSgrl]

You were acting within your protocols, so right there you don't have anything to worry about. Also, if she had been hurting for a while then obviously something is wrong and since our job is patient care then you took care of your pt, which is the right thing to do! Good job.

[zippyRN]

Hey everyone:

I was on a call this AM where a 71y/o lady had fallen 3 days ago and she had severe pain in her legs, arms, and chest wall. we could not move her so I gave her morphine (as per our protocol) this helped, we got her out. So I gave report and the doc was there. When I said I gave Morphine he said we give narcotics way too much. when it is not needed. We could not even move her an inch with out her screaming in pain. I thought it was warranted what do you all think?????

Canuck EMTP

how much morphine did you give?

any other options in the drug box ?

entonox if you have it is probably contraindicated even if she could self admin

[canuckemtp]

I gave her 7.5mg IM protocol is 5-15mg (could not get a line) I did not want to totally snow her. It worked well. we also carry demeroll, fentanyl

but protocol is longer than 20 min transport time go with morph.

[Ridryder 911]

Apparently the Doc doesn't know but he is about to get busted by JCAHO on pain control. He must not keep up on the new issues of controlling pain... just wait.. he will have a new attitude after review.

Research has shown that pain management in ER is too low and those with perceived "drug seeking" behaviors are usually not founded.

Be a patient advocate and do what is right for the patient.....

Be safe,

Ridryder 911

[flight-lp]

I think this is an issue that is really misunderstood and undertreated. My personal thoughts (and the protocol of our medical director) is drug 'em till they drool!! Consider this........How can you objectively tell what a patients response to pain is. Answer, you can't. Pain is exactly what the patient tells you it is, plain and simple. Our analgesics that are routinely administered can be reversed should hemodynamic or respiratory side effects present. I do understand the frustration when you know that a patient is completely blowing smoke up your ass for meds, but can you without a shadow of a doubt objectively and factually state to the judge and jury that the patients pain was not what they described? I'll bet a years salary you can't. I don't like it, I don't agree with the stupidity and addictions of society, but I have learned to deal with it. Treat your patients with an assumptive attitude and you will be the one who thinks that the massive non Q-wave MI that the cocaine addict is having is only looking for an excuse to get some Morphine...................