Do You Feel You Have the Ability To Adequately Control Pain?

[scope2776]

Do you feel you have the ability to adequately control your patients pain?

I believe many EMS agencies are short-changed when it comes to their ability to control pain and whereas this is one of the most positive impacts we can make in caring for patients. Also many painful experiences are made more painful by extractions, moving and transportation to the hospital, therefore EMS agencies should have aggressive treatment protocols. Please share your pain medication protocols or other tips you have for pain management as well as any medications you prefer.

If you voted no please explain why. And what you think would improve your situation.

I would also like to know if anyone has protocol for, or has used, pain medications IM. For example using in a pt with stable vitals and extreme pain before an IV has been established or if one cannot be established for whatever reason, before you move/extricate them. Any advice on the practicality or safety of this method?

Here we have Morphine, Valium, and Fentanayl. Morphine is given in 2-4 mg doses, but also has protocol for 0.2mg/kg IV. Standing orders for Valium are 5-10mg IV adult and 2-5 mg pediatric. and Fentanayl is 1mcg/kg with a max of 100mcg. We are allowed to administer all of these together at will without calling med control. We are also allowed to administer more with med control permission, which normally isn't a problem. We also can call in for morphine 0.05-0.2mg for pediatrics. And we are held accountable for using capnography, pulse ox and having every patient we give pain meds to on O2. There has been talk of expanding pain protocols if more paramedics do this....

Thanks!

[scratrat]

The only time we can use pain medications under standing orders are for the following two:

Demerol 12.5mg only for lower back pain. Not real descriptive, but it's our discretion.

Morphine 2-4 mg for isolated single fractures, IE arm, or femur. This one doesn't necessarily say you can't use it with a femur fracture associated to an MVC, but I wouldn't. Again, it's our discretion.

Anytime we don't feel comfortable, we can med control. Or we can call for additional orders.

[akroeze]

Demerol 12.5mg

Wow, that's a very low dose!

[scratrat]

Brainfart...that was supposed to read 25 mg. I don't know what happened...

That's if I want to do it under standing orders.

I can call and get orders for 50-100 mg.

Hey, I take what I can get. In New Jersey we could not administer ANY narcotic for any reason without the express permission of medical control. You can use "Communication failure protocols", which is exactly what it sounds like, but you must document out the butt and notify the supervisor, and basically it's more hassle then it's it worth.

[scope2776]

Hey, I take what I can get. In New Jersey we could not administer ANY narcotic for any reason without the express permission of medical control. You can use "Communication failure protocols", which is exactly what it sounds like, but you must document out the butt and notify the supervisor, and basically it's more hassle then it's it worth.

Wow... that is simply unacceptable. Where in New Jersey? Is that still the rule??

[Dustdevil]

I can assure you that I do not shortchange my patients when it comes to analgesia. I am quite liberal about it, paperwork be damned. But yes, I do think that inadequate pain control is a serious problem, not just in EMS, but in medicine in general. I spent almost a week in the hospital out here several months back and experienced the problem first hand. Some of the worst pain in my life, and yet they couldn't seem to get past the old "2 milligrams at a time" box of thinking because that's what their books said back in nursing school, and they've always done it that way. Never mind that I was obviously not getting ANY relief, and that I wasn't even getting drowsy, much less getting dangerously sedated. So WTF?

I've seen it a lot in EMS and in hospital and clinical practice, and it always pisses me off. Times are changing, but all too slowly.

[Ridryder 911]

I agree this is an area that EMS is very lacking in. Part of the problem is most of the medical directors and orders come from the mentality of ER physicians (sorry Doc's). They assume most of the patient's that are in pain are seekers... (as they usually are in ED's) but this carries over to EMS. ER's have had a battle convincing pain management for years, until JCAHO stepped in and required pain management programs and requirements.

There appears to be no continuity of degrees of what is acceptable. I understand pain is subjective evaluation, but not to allow adequate level of analgesics for specific events is cruel. Ironically, some physicians will load patients up on analgesics, while others barely treat at all. I can usually tell the difference between an FP and ER quickly.

We are in the midst of adjusting our analgesics, and I am discouraged. We have retrograded instead of advancing. At least a few of us fought for Toradol for renal calculi and muscle skeletal injuries. We have the usual M.S. & Valium, but that is all now. Hopefully, we can adjust for more later.

R/r 911

[Timmy]

No, No I don’t and it sucks. I hate not being able to give pain meds! My service has just gone into getting its members qualified and competent in using Penthrane.

Even when we can use it, it’s only an analgesic and won’t make a difference for some patients.

I hate seeing little kids in pain. I remember one time at MX we had a kid come off w/ a # knee. I was on the second crew to respond but as we ran across the track I could hear his bloodcurdling, agonizing screaming echoing around the track and there was nothing we could do about for the 50 mins it took the paramedics to arrive.

I often lye to patients saying the 02 mask is pain relief in an effort to try and make it into some sort of placebo and it sometimes works but not often. We sometimes have patients pass out from the pain and I feel so guilty I can’t do anything more for them.

I hate it some much when patients grabs your hand, squeeze your figures with what ever energy they have left, look you straight in the eyes with a look of complete desperation and say “make it stop, please make it stop” or when the parents are offering you bribes to stop there sons pain or scream at you with angry tears in there eyes.

I do wish Australia would change some of its event medical policies so first aid services aren’t covering events that in realty require intensive care paramedics or even full on medical teams.

I seriously can’t wait to become a paramedic!

[AZCEP]

Yes, I think that I am able to adequately manage a patient's pain, but...

I do not stay in the proverbial box for this one. There are many ways to manage pain that don't necessarily require a narcotic to do so. Limiting movement, putting the patient at ease, simple ice packs occasionally can reduce pain to a degree. IM meds can be used if needed, and I've used them for pediatric burn patients. Stops the squirming so the IV is much easier to start.

We only carry morphine for specific pain relief, but I've found that a dose of Benadryl adds to the effectiveness quite nicely. Valium does nothing for pain, but it will help to reduce the CNS involvement. I've also dosed ASA for pain other than cardiac. Amazing how many times it is forgotten.

[Dustdevil]

Months ago, we had an MCI and the ER was to capacity with casualties. The group I was working with was new, so we had not worked a lot together and didn't know each other's styles well yet. I had a patient with major multiple trauma from an IED. Holes all over him. He was going to surgery as soon as a suite opened up. I gorked him out of his head with fentanyl. He needed it. Some ER doc started to go off on me. He was quickly brought down to earth by the surgeon, the anaesthesiologist, and the head nurse, who said they would have done the same thing, and assured me that the patient would be thanking me... if he were not currently snoring.

Bout 20 years ago, I had a chest pain that was a classic MI presentation, and I was comfortable with that diagnosis. I had given him probably 6mg of MS by the time we got to the ER. As soon as I gave the doc my report, he rolled his eyes and went into a lecture about how inappropriate it had been to give the guy MS when it obviously was not an MI. About fifteen minutes later, the doc tracked me down to humbly apologise after looking at the 12 lead.

It's the small victories that keep us going!