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

[AZCEP]

Just to clarify, Etomidate, Versed, Valium do nothing for the pain. They are not analgesics and do not have that property. They are sedative/hypnotics. Meaning, they will "disconnect" the brain, but not shut it off. The patient still feels the pain, but is unable to respond to it.

Versed and Etomidate are great combination agents so you don't have to use as much of either one. Less Versed is less likely to affect the hemodynamics, and less Etomidate is needed to induce a hypnotic state.

[Connie31079]

I voted "no", simply because all we have for pain relief here is Morphine.

We've been asking for another narcotic for years, but so far, no dice.

I've had multiple patients over the years with an allergy to morphine, and guess what? I couldn't give them anything for pain, and they had to wait until we got them to the ER in order for the doc to give them something for pain.

It's so frustrating at times.

[croaker260]

Wow, cool, etomidate for cardioversion? Have you ever used it? I noticed you also have versed. I've always heard versed as being the superior choice for cardioversion... have you been able to compare either?

Your etomidate pain relief dose is almost our RSI dose (0.2mg/kg).... that's kinda sad....

Thanks for the great responses!

Etomidate for cardioversion is the only part of our protocol that is a call in (or diviation proceedure) so it is not done that much, most prefer Versed...That said, in the event that the patient is grossly hypotensive, it is a good option

[Timmy]

Entonox i feel is a seriously underused drug at the basic levels of pre-hospital care

I so totally agree! They won’t let people who are willing and more than capable to learn how to give basic analgesia but there more than happy to staff a MX event with 400 riders or a major speedway meetting with level 2 first aid officers and a fishing tackle box.

Do you have any idea how hard it is to get a license to administer basic analgesia if you’re not a health care professional? Australia has things so very wrong lol

[flight-lp]

I so totally agree! They won’t let people who are willing and more than capable to learn how to give basic analgesia but there more than happy to staff a MX event with 400 riders or a major speedway meetting with level 2 first aid officers and a fishing tackle box.

Do you have any idea how hard it is to get a license to administer basic analgesia if you’re not a health care professional? Australia has things so very wrong lol

Exactly as it should be! And they will let you give basic analgesia................Just become a Paramedic.

[canuckEMT]

The service I am hoping to work for has fairly liberal protocols for pain control. We have access to Moprh, Fentanyl and Entonox. It also has just been adopted that we can also add midazolam (only benzo they carry) with the analgesic.

Morphine: 2.5-5 mg q 15-30 min prn to max 20mg

Fentanyl : 1-3 mcg/kg to max per dose 200mcg q 5 to 15 min prn

Midazolam: 1-2.5 mg titrated to response in combination with analgesic

I haven't given any analgesics IM in the field. I guess I have been lucky and all my patients so far have opted for IV analgesia. I do employ the use of Entonox quite frequently if the pt is stable while preparing IV and meds prior to moving the pt or splinting any fx's.

[Imagine89]

I so totally agree! They won’t let people who are willing and more than capable to learn how to give basic analgesia but there more than happy to staff a MX event with 400 riders or a major speedway meetting with level 2 first aid officers and a fishing tackle box.

Do you have any idea how hard it is to get a license to administer basic analgesia if you’re not a health care professional? Australia has things so very wrong lol

Uh yeah, that's because narcotics can be dangerous. Of course you have to be a healthcare professional, it only makes sense. As a basic I know I wouldn't feel comfortable administering MS etc.

[akroeze]

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.

25mg is a pretty low dose still but better than 12.5

I guess I'm speaking from a surgical Nurse background and not a field perspective. 50mg minimum.... frequently 100mg. Do you also automatically mix in an anti-emetic with it?

Basically every patient I ever had would have 50mg Demerol and 50mg Gravol PRN as a minimum.

[medic82942003]

The detroit drug box I use Detroit MI. We dont carry any pain meds except valium. I am not kidding.

[Rezq304]

Can I adequately manage pain?

That's a double edged sword. For some yes, for others no. I had a girl with an obvious tib/fib Fx that got a total of aobut 20mg of Morphine with no relief.

On the other hand, I had another girl with a broken ankle where 2mg Morphine & 12.5 of Phenergan put her on "cloud nine".