Pain Management

[Timbo7]

I have been an EMT for a little over a year. I consider myself above average in how seriously I take my job. I put a lot of stock in pain management, being an EMT for now, I don't have much to work with but I'm quick to call for an AEMT or MEDIC to deal with substantial pain. Unless it's an obvious minor injury I take my patients pain level very seriously and ask for additional resources as necessary. Knowing that pain relief plays a big part in recovery guides my philosophy on this. I've gotten a few rolling eyes, but I feel if I can make my patient more comfortable for 20 minutes with the possibility of improving outcome I've done my job. Thoughts?

[island emt]

pain relief for our patients is often overlooked by many.

there are many different methods you can use as a Basic EMT.

proper immobilization , ice packs & positioning to reduce strain or stress on the injury.

Don't ever be afraid to call for an advanced level provider to provide pain relief through narcotic intervention.

[Just Plain Ruff]

Plus many of the medics I know will never hesitate to stick a needle in a arm and push a pain med. It's what they live for.

[1EMT-P]

All too often we forget the basics when caring for our patients... Sometimes all that is needed is for us to address our patients concerns and use the basics such as deep breathing, immobilization, listening and positioning.

[mikeymedic1984]

I am not discounting the need for "pain management", but I imagine you will get the "death stare" from some medics if you call them routinely. There are too many drug adicts that always state their pain is a "10" out of 10, when they are sitting there calm and collected with average vital signs. Assuming you have a decent nose for sniffing out the "seekers", you then have to make sure you are utilizing your resources for "all of your service's patients", not just your patient. For example:

1.You are 20 minutes from the hospital and you have a "10 out of 10" patient, and then choose to take the last ALS ambulance out of service to come to your call; and then you wait on their response to scene, give report, and then do whatever you have to do to turn the patient over from your care, then that is stupid as you could have already been at the ER. There may be other patients who needed that ALS resource more (MI, Cardiac Arrest, a patient in greater pain, etc....)

2. Is your available pain meds on the ambulance the most appropriate med for the condition ? I hope you are not giving morphine to all migraine patients; you should have some lower level meds available like Toradol or Fentanyl (even Motrin/Tylenol for that matter). Just because you have narcs on board does not mean that you have the best med for a particular illness/injury.

3. Unless it is an injury that just occured, most "pain patients" have been in pain for hours, days, or weeks. Another 20 minutes of waiting will not kill them.

Conversely, if your ALS units started calling you to their scenes to transport every patient that they find does not need ALS, would you be cool with that ?

[chbare]

Pain is a pretty subjective experience and addicts also experience pain. I ended up in the hospital last year with a prostate infection, in terrible pain. Because I appeared calm and collected I was not given pain medications. I was able to convince a PA to write me a script for a few tablets of pyridium however. Don't assume you know how to weed out fakers, you may very well be incorrect.

Fentanyl is certainly not a "lower level" medication than morphine. Neither is Toradol. Also remember fentanyl is an opioid analgesic like morphine.

Twenty minutes of severe pain is twenty minutes of suffering. The evidence is rather weak in supporting the life saving potential of EMS, but being able to respond to pain and suffering is actually something that we have a bit of control over. If anything, managing pain is a primary indication for ALS care.

[mikeymedic1984]

Ok chbare, it is late July -- how many times have you administered pain medication this year (not including chest pain) ?????? Be honest. And I am sorry, it is not possible to be in "10-10" SCALE PAIN and not have elevated vital signs. You can have some pain, without elevation, but you cant convince me that you are having the WORST pain of your life with vital signs of 110/60. 64, 16.

If I can wait 30 minutes on my pizza, I can wait 20 on pain meds, especially for a chronic condition.

Edited July 28, 2014 by mikeymedic1984

[Just Plain Ruff]

Mikey, do you have a chronic condition that requires pain meds on a regular basis? If you do not then you really do not have any room to judge.

I have a friend who's daughter is being treated for bone cancer. She is in terrible pain most of the time. She also suffers from chronic pain as well. Do you want to tell her that she can wait 20 minutes for her pain meds because you think she can???

Go ahead and tell her dad that she can wait, I'm sure he would feel differently than you.

[mikeymedic1984]

If you have "chronic pain issues", your regular doctor should have you covered for that. Typically, drug seekers with "chronic" conditions call EMS on Fri/Sat/Sun, because they can say their doctors office is closed, so they can only get meds from the ER ------------ BS ! If I have a chronic pain condition, you can believe that I would not run out of meds. I would go to my Doctor, before I am close to running out.

It is funny that no man ever has the need to go to the ER for his Viagra. They seem to always have enough to get through the weekend. If you have failed to get the meds you need, then shame on you.

If you are close to running out, you can call your doctor for a refill -- funny how chronic pain patients never seem to run out of meds during office hours.

Edited July 28, 2014 by mikeymedic1984

[Just Plain Ruff]

Glass houses my friend, glass houses.

And you call your doctor for a refill, he may take several days to get the refill called in.

There are a myriad of reasons why you may run out.

Yet all you see in this conversation is that if someone suffers chronic pain they should never run out.

The best case scenario would be that they never run out but there are times when they do.

My grandmother had chronic pain, my grandfather was the keeper of her medication, he was very meticulous about making sure all her medication was fully stocked but one day he forgot to get her refills. She ran out one afternoon and by evening on thursday night she was in severe pain. so much that she needed an ambulance to take her to the ER. The distance to the ER was about 45 minute drive. By your logic she should have to wait because well you can wait for your stinking pizza so she should have to wait for her pain relief.

And actually I had a patient in the ER one time ask for a refill for his viagra because he did indeed run out. The doctor told him no. The guy was less than pleased.

Edited July 28, 2014 by Ruffmeister Paramedic