How many can give pain meds for abd pain?

[spenac]

(spin off). How many can give pain meds for abd pain? What are some of the reasons for or against in your protocols? Thanks

[scratrat]

I can't do anything for abdominal pain without a doctors orders.

That said, I ironically had a guy this morning with bilateral lower quadrant pain associated c/ N/V and CP from the repeated wretching. I called for orders for phenergan for the nausea. He vomited at least 5 or 6 times just with us. Instead, the doctor gave me orders for 12.5 of phenergan and 4 mg of morphine for the abdominal pain.

Someone enlighten me. I was always taught that morphine was NEVER to be given for undiagnosed abdominal pain??

[AZCEP]

Narcotics can, over time, cause the peristalsis to slow or stop completely. This CAN worsen an obstruction.

There is also the long held myth that the morphine will mask the pain, making it more difficult for the physician to assess the situation. Most will allow for smaller, more frequent doses if it is needed.

We can medicate for abdominal pain, and I often do.

[CBEMT]

It's not specifically in the protocol, but I spose I could call and ask for it. With only Morphine as an option however, even enlightened MC docs would probably say no.

[pyroknight]

Ye olde conventional wisdom is changing on this topic. Most physicians have figured out that patients in excruciating pain will not allow a thorough examination. By reducing the pain to a tolerable level, the pain can be localized more effectively.

I believe this is beginning to filter down to EMS. Treating pain is a hot topic in the clinical setting and many EMS medical directors are allowing more administration of analgesia.

The service that I work with administers fentanyl on standing order for abdominal pain.

[Spock]

I have had several conversations regarding abdominal pain and opioid analgesia with our chief of surgery. He is adamant that this is a bad idea and the only thing preventing more bad outcomes is the sophistication of imaging such as the new generation CT scanners. That said, there is a growing body of literature suggesting analgesia for abdominal pain is reasonable. Interestingly enough, the literature is mostly written by ER doctors and not surgeons. I have never agreed with the all or none philosophy and think every patient must be treated as an individual. Therefore, I would say it is reasonable to call command and ask for orders for opioids after a thorough exam. I don't support a standard order for opioids for these patients.

One other consideration is if the abdominal problem requires surgery, can a patient sign an informed consent after receiving opioids? I doubt that a small amount of opioids would interfere with the decision making process but an attorney might argue otherwise.

Analgesia for pain is the forgotten epidemic in all aspects of medicine and we all should strive to do a better job of helping our patients. Every time I hear somebody say "he doesn't look like he is in pain" I go ballistic.

Live long and prosper.

Spock

[pyroknight]

Is a patient who is basically demented by pain making a truly informed decision? I would say no. If you are so distracted by pain that you cannot listen to the risks of your options, how do you decide? Most people in significant pain just want you to do SOMETHING, ANYTHING to make it go away. Physicians can be sadists, lol, but, so can medics!

[canuckEMT]

I have administered Narcs for abd pain during my last practicum after discussing it with my preceptor. Although I did use a lower dose than I would use for other forms of pain ( fentanyl 1mcg/kg VS 2 - 3 mcg/kg).

[ERDoc]

This is one of those topics that really gets me agitated. If your pt is in pain, you treat them. Spock, your surgeon needs to read sometime. It has been shown that pain is decreased by analgesia, but tenderness is not. This is a good thing because your pt will not be in pain and you will be able to better assess where they are hurting. To do anything else is cruel and inhumane. He is speaking like a true, old-school surgeon who has not kept up-to-date. Here are a few links you can pass along to him:

http://www.ncbi.nlm.nih.gov/entrez/query.f...l=pubmed_docsum

http://www.ncbi.nlm.nih.gov/entrez/query.f...t_uids=16953529

http://www.ncbi.nlm.nih.gov/entrez/query.f...st_uids=8959160

http://www.ncbi.nlm.nih.gov/entrez/query.f...t_uids=12517545

http://www.ncbi.nlm.nih.gov/entrez/query.f...t_uids=17032990

That is just a few and I think one is from the surgical literature. Of course most of the studies come from ERs. Where else do you see acute abd pain? The only reason you should ever withhold appropriate pain mediciation is when your pt's VS as unstable. Even then you have fentanyl (assuming your area allows it).

AZCEP, you are right about narcotics leading to constipation, but giving them to someone with an acute abd will not be a problem. Even if they are obstructed they should not be in pain. The obstruction will soon be relieved once they are in the hospital. The problem I have is giving heavy duty stuff to pts with mild pain. There are a large number of docs in my area that automatically give 2mg dilaudid to anyone who walks in c/o pain, reguardless of where the pain is or how severe it is. It is no wonder we have such a drug seeking population in my area. No nurse where I trained in NY would have let an order like that go by without seriously questioning it.

[scope2776]

We have no limitations on pn control for abdominal pts. I won't totally snow them with meds so the doctors and nurses can get some kind of assessment...

The administration of Morphine to a pt with cholycistitis or other gallbladder pathologies can actually make the pain worse by contracting the sphincter of Odi. Therefore in the pt that presents with pain, that through history and assessment, I believe to be related to the gallbladder I will use another pn med or a benzodiazepine.