ERDoc Posted November 14, 2013 Posted November 14, 2013 I think we need an American to Canadian translator on this site, lol. It looks like Maxeran is the same thing as Reglan, both of which are metoclopramide.
paramedicmike Posted November 14, 2013 Author Posted November 14, 2013 Good idea! Please report to the wiki thread.
MariB Posted November 14, 2013 Posted November 14, 2013 We have a lot of experience with narcs here. Fentenyl works great but can give the girl headaches and doesn't last long. Morphine and dilaudid makes her so she can't pee.. She like phenegran Toradol works OK, but takes a while to kick in and only takes the edge off Vicodin works good, makes her sleepy Percoset takes all the pain away but makes her face itch Oxycodone good, but sleepy
mobey Posted November 14, 2013 Posted November 14, 2013 I think we need an American to Canadian translator on this site, lol. It looks like Maxeran is the same thing as Reglan, both of which are metoclopramide. Yes, Sorry. Should just speak in generic names. ....Links to a few studies for those who are not familiar. Exact mechanism is unknown, but results are statistically significant to support it's use. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3341930/ http://www.bmj.com/content/329/7479/1369
paramedicmike Posted November 14, 2013 Author Posted November 14, 2013 For migraines I'll usually use 10 mg reglan, 30 mg toradol, 25-50mg benadryl and a liter of fluid. Turn off the lights and let them sit for a bit. Absolutely no narcotics for migraines. None. Zippo. Zilch.
Just Plain Ruff Posted November 14, 2013 Posted November 14, 2013 For migraines I'll usually use 10 mg reglan, 30 mg toradol, 25-50mg benadryl and a liter of fluid. Turn off the lights and let them sit for a bit. Absolutely no narcotics for migraines. None. Zippo. Zilch. Just let me know when you work so I don't come see you, you party pooper you, stinky pants
Kiwiology Posted November 14, 2013 Posted November 14, 2013 Migraines are funny business; I hear they are often not best treated with narcotics but I don't know much more than that; the line of thinking in the ambo realm is if the patient is in severe pain then give them morphine or fentanyl. If you're interested the Faculty of Pain Medicine of the Australian and New Zealand College of Anaesthetists deals with chronic pain down here. http://www.fpm.anzca.edu.au/ As an aside, what are y'all using in-hospital for acute pain; some bloke with angulated femurs or something?
island emt Posted November 14, 2013 Posted November 14, 2013 separated and dislocated my shoulder a couple winters ago falling on the ice. Picked my self up and drove to the ER. Of course all the nurse had to bust my chops. They started out with 100 mcg's of fentanyl didn't touch the pain ,added another 100 mcg, just took the edge off Then came dilaudid Don't remember how much ::: or much of anything else after that for about an hour. when I next remember is when the ortho doc popped the shoulder back into place with the old yank & pull while my friendly ER nurses held me down. Then came vicoden po. Yep could learn to like them. took 4 over the next 24 hrs and stopped that foolishness. ER Doc offered me a choice of prescriptions to take home. Easy to see how addictive personalities can get hooked on the harder narcs.
ERDoc Posted November 14, 2013 Posted November 14, 2013 On this note, how often do you ER types prescribe narcs for pain of unknown etiology? My chest pain ER visit comes to mind, and they tossed me out with a scrip for 30 vicodin, which I said I didn't want, and when they made me take it with me anyway I promptly deposited it in the shred box up on my home floor when I went to retrieve my stuff from my locker. Was that wierd, or par for the course? Wendy CO EMT-B RN-ADN I rarely write for more than 20 narcs and it is 99% of the time for norco. About the only time I wrote for more or something stronger is for someone with a real fx that is being sent home. I'm using Ultram more since I can eprescribe it and it works well. Just because we can't find the cause of some pain in the ER doesn't mean it isn't painful. Unless I have a concern that pain meds will mask something and delay the pt from coming back if they need to, I have no problems prescribing a very short course.
paramedicmike Posted November 14, 2013 Author Posted November 14, 2013 My colleagues write for a lot of percocet and quite a bit of vicodin. I think ibuprofen would take third on the list. Tramadol is common, too. Legally I can only write for 48 hours worth of narcotic pain medication at a time. I'd like to think this encourages primary care follow up for ongoing pain control but that's probably a bit naive. Of course, there's always the folks who will come back in two days saying they're out and need more. What I choose to write varies. If you have a fracture you'll get some good pain meds. Usually that's percocet. Otherwise, I try to evaluate on a case by case basis and what I'll write for will depend on what's going on. What's hard is that there's a fine line between being compassionate in pain control and being a hard nose about it. As my experience improves I think I'm getting better at ED based pain control. At least, for the sake of my patients, I hope I'm getting better.
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