giving Narcotics like candy

[Dustdevil]

Have you been using the narcotics like candy?

Now that's funny right there, I don't care who you are!

[temsp40]

Ok -- we have now had the Star Wars side line junk -- back to business.

I feel that as long as you act within the protocol and inform your patient of a) what you plan to do, what the potential side effects of what you plan to do could be, and c) you do as an advocate of the patient, then the doc that made this comment can go pound sand!

I am a firm believer in pain control, and I will tell you all that MS doesn't actually take the pain away, but after a couple minutes, you really DON'T CARE about the pain anymore (yes, I know from personal experience) -- but Fentanyl is MUCH better -- the pain goes away AND you didn't care about it anymore!

As far as measuring "how much pain" your patient is having -- I can only go by what they tell me, if it hurts where the patient reports having the pain and degree of suspicion as to the validity of the pain. Although , one needs to treat pain similar to chest pain (but this theory is mostly outdated because we can prove reasonable doubt now) until it can be proven as NOT cardiac chest pain, treat it as cardiac related chest pain. (This was my theory before 12-leads were the standard of care, I know that we can, do and will continue to do 12-leads to rule out MI in all of our chestpain patients.)

[Dustdevil]

That brings up a good point that I'd like to hear some of you address. How has the field use of 12 leads affected your use of narcotics for chest pain? If the EKG is negative for signs of an MI, does that make analgesia contraindicated in your protocols or judgement, or the judgement of your online medical control? Or do you still treat the pain the same way as you would have otherwise without a 12 lead?

[PRPGfirerescuetech]

Just a thought,

Pain is a complete intangible. We have no "pain-o-meter".

That being said, can you really deny a patient pain meds, if their is no contra-indications, IE: Social hx, allergies, mental status, etc...etc....

Just my 2 cents.

PRPG

[AZCEP]

Using technology has not significantly changed how pain is treated here. Most of the medical control physicians are less likely to allow it than before, but not because the patients have changed.

PRPG, I tend to disagree that pain is intangible. The person that is feeling it will tell you that it is very real. It is very subjective, because each patient/person that feels pain will rate it differently. Most of the time we are looking for changes in the pattern associated with the pain. If we assess a 9/10 to start with, and this changes in either direction, we have, in effect, monitored the pain.

[nsmedic393]

I think wat PRPG is trying to say (and if he is I completely agree with him) is that we have no way of measuring how much pain a patient is in. For example if a patient were to say that their heart rate was 180, I can very fy that by looking on the monitor or take a pulse and treat that paitent acordingly. However, a patient can say that they are having pain and since we have no way to verify, we should give them the penifit of the doubt and treat for pain.

When it comes down to something so subjective I would rather take the chance on giving someone pain meds who is faking an ilness than guess wrong and withold pain control from someone who really needs it.

[PRPGfirerescuetech]

I think wat PRPG is trying to say (and if he is I completely agree with him) is that we have no way of measuring how much pain a patient is in. For example if a patient were to say that their heart rate was 180, I can very fy that by looking on the monitor or take a pulse and treat that paitent acordingly. However, a patient can say that they are having pain and since we have no way to verify, we should give them the penifit of the doubt and treat for pain.

When it comes down to something so subjective I would rather take the chance on giving someone pain meds who is faking an ilness than guess wrong and withold pain control from someone who really needs it.

Absolutely is what I meant. My apologies for the miscommunication. Pain is incredibly subjective, as well as intangible. You cant look at someone and know how much pain their in, what their pain tolerances are, and if they truely "need" something from the "Pain management family".

Something to think about...

[Richard B the EMT]

Tangent: Pain Management and Pain Tolerance..

When having therapy for the torn meniscus (1997), I was having "EMS", as in Electrical Muscle Stimulation. Basically, I was having my leg electrocuted.

Usually, the therapy is a slow ramping up to the charge the therapy requires.

One time, the machine malfunctioned. The indicator said I was getting the "jolt", but I wasn't. As the "techie" went to get the supervising tech, with no warning, the machine gave me the full power jolt.

I think I was levitating midway between the table and the ceiling from the pain, for about 5 seconds, as the the techie rushed back in to shut it down.

Tolerance developed, as in the next few weeks, I was sleeping with a higher voltage going thru me.

When I had the aneurysm in my leg (2005), I had intense pain. At the hospital, prior to the corrective surgery, asked to describe it ("if the worst pain you've ever experienced is a 10"...), I reported an 8.5. They gave me Morphine to ease the pain, but the morphine didn't "kick in" for 2 hours after they administered it. The morphine given, dosage now forgotten, was supposed to have been a sizable "jolt".

[kevkei]

Just a thought,

Pain is a complete intangible. We have no "pain-o-meter".

That being said, can you really deny a patient pain meds, if their is no contra-indications, IE: Social hx, allergies, mental status, etc...etc....

Just my 2 cents.

PRPG

So then do you give analgesia to every patient that you have complaining of pain? To look at someone that is pink, warm and dry, in no obvious visible distress, BP 110/60, HR 64 and resps of 16, you can say there is no pain-o-meter? If someone presents with "severe" pain that clinically looks like the presentation above, I doubt their pain is as severe as they make it to be.

You have to be able to form a clinical picture from the global presentation of history, chief complaint and clinical signs and symptoms. Treating pain has to be discretionary, just as is the case with giving ASA, decompressing a chest, intubating, etc. There is no black and white.

DustDevil- someone that presents to be cardiac chest pain gets MONA (regardless of 12 lead presentation) until cleared by troponins.

[canuckemtp]

I agree with kev all patients cardiac chest pain recieve MONA no matter if there is ST changes. In our protocol we will give thrombolytics with ST changes.

CANUCKEMTP