Pain Management

[Trauma_Dog]

Just wondering what kind of adjuncts all the other services are using for pain management?

Currently, we are using Fentanyl, Stadol, Morphine and Nitus Oxide. Our Drugs of choice or should I say my medical directors choice is Nitus Oxide and Fentanyl combination.

I took a while for the ED doc's to get used to the idea, but now they often ask how we didn't given rather than why did you give it. Your thoughts, inputs, bitches, gripes and complants are all welcome.

The Dog

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Kent Simon
Paramedic Incharge
MCHD EMS,
Montgomery Co.,TX

[Medic019]

Our pain management include Morphine and Demerol...That's it...It would be nice to have some others to fall back on also..

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Firefighter/Paramedic in Northwest Pennsylvania... Stay Safe

[MM187]

Morphine. Period....Would be very nice to have some other choices...

[Romania]

All we got is MS also, we have Nitrus avalibe (per Dept. of Health Services) but most base stations don't allow it. I wish we had more, as we all know M.S. doesn't work on everyone, or every problem. In fact, I had a pt who presented with kidney stone type s/s last shift, got orders for MS, as much as I needed (it is good to talk with a doc who I have heard say "I have more meds than he has pain, and more fluids than he has bladder capacity.") however M.S. made his pain worse. I'll send a local 3449 union shirt to the person who can figure this one out. If needed I'll post more info. Have fun... email me with guesses http://www.firehouse.com/interactive/boards/smile.gif

[Boothby]

We carry MS and Stadol. I have not had any problems getting orders for either when needed.

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Larry Boothby
Firefighter/Paramedic
Truck 3 A-shift
Local 1784
Memphis.

[Trauma_Dog]

Our medical director has just given us a 4 hour class on pain managment in which several issues were adressed, physiology, acute vs chronic and psychological. The psychological can be applied to those of you who only carry MS.

Just as a trial before you give the pt the pain medication talk it up, tell them it is the best stuff in the world for "this type" of pain and it should be aganst the law for you to give it too them. Well you don' thave to go that far, but I would like to see if your mental preperation for the medication has an effect. I have seen an increase in the efficacy of the meds when I have done this, let me know what you think. The Dog.

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Kent Simon
Paramedic Incharge
MCHD EMS,
Montgomery Co.,TX

[Pamela Baber]

Agree that it would be nice to have other choices than MS. Curious about Romania's pt. with Kidney stone Like pain and the order for MS. Usually not given for pts. with the potential for hepatic disease (can cause urinary retention), or was that ruled out?

[Squad33]

I gotta agree with Trauma_Dog on the talking up your drugs. Had a pt who stated he was in an incredible amount of pain and got relief from the ns he felt going in from the line we had just started. He said we had better meds than the er, so we just let him think we had the goods.

[skymedic]

Here in Namibia, we're mostly guided by the South African protocols. They're restricted to Tramadol (Tramal) and Nalbuphine (Nubain), plus a mix of 50% Nitrous Oxide and 50% Oxygen known here as Entonox.

Lately we've added Morphine to the repertoire, with good success.

Entonox dosen't get used much because of the potential complications and side effects, as well as the costs involved.

Unfortunately, Nalbuphine's registration expired here over a year ago, and nobody seems to want to re-register the drug. Pity, 'cause it works really well (dosed IV at 0.1-0.2 mg/kg)

Tramal is the opioid most commonly used here, but it is a strong emetic, so we often give patients a dos of Maxolon (Metoclopamide) before the opiate. We've also found some frightening cases of convulsions induced by Tramadol. (see posting on EMS forum) Any feedback will be appreciated.

Michael Dollenberg
Operations Manager / Flight Paramedic
Aeromed Namibia

[Romania]

Pam, You are right, MS is also (relativly) contraindicated for any undiagnosed adominal pain, but my medical director (and I agree) feels that it is more important to relieve the patients pain. Or at least attempt to. You also need to consider the setting and max amount of the medication the pt will recieve. Will 5-10mg of MS given in the field cause urinary retention... probibly not. Will higher doseges over time cause urinary retention... probibly.

Any guesses on my last post http://www.firehouse.com/interactive/boards/smile.gif

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Alan Romania, CEP
romania@uswest.net
IAFF Local 3449

My Opinions do not reflect the opnions of the IAFF or Local 3449.

[fyrmedik]

We have MS...that's it.....would be nice to have other choices.

[FIREMEDIC BILL]

All we have is MS. I had worked for a service previously that carried MS and stadol. I dont have any problems getting orders for MS.

Be safe.

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FIREMEDIC BILL JENNINGS
GWINNETT FIRE/GRAYSON GA.
STATION 8-B SHIFT
ENGINE AND MED 8

[Ledbelly]

We have nitrous, period. There's been a lot of cussin'/discusin' lately because our new protocols were out last... Aug... and they have MS. (but only for burns/fx) [Course, protocols also have aspirin and ER wants to know why we never give it... "Well, Doc, we'd of had to stop at 7-11 and buy some and didn't really want to stand in line?] We still haven't figured out if the roadblock is coming from ER or our Dept. Facetiously, it appears that if they're complaining of pain, then at least we know their LOC...?

[SCMedic45]

Are we becoming pharmacies or what? I don't know about you all, but keeping up with all these controlled drugs can be a painstaking task. MS has been, is, and will probably be the best narcotic pain medicine ever made--it does not get any more basic. The agonist/antagonist such as Nubain and Stadol are nice in theory, but you give it to a narcotic dependent patient who is not truthful with you (a patient not being truthful--who would think that?) and you have a mess on your hands. Demerol is great for those allergic to MS. Why clutter your drug box with liabilities and fancy synthetic opiates when MS and Demerol have worked for years. If it ain't broke, why fix it???

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Hamilton RN,CEN,EMT-P

[jedge168]

Like several others we don't have anything but Morphine. Would be great to have Nitrous I think for simple fractures and whatnot.

[Trauma_Dog]

I understand that you have to keep up with the narc's, but that only takes about 5 min. in a face to face transfer of the meds and a couple of signatures. Morphine and Meperdine are just as habit forming as others. How do we know if other things will work better if we don't try new things?

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Kent Simon
Paramedic Incharge
MCHD EMS,
Montgomery Co.,TX

[HILLBILLY70]

MS,Valium,Versed,Fentanyl,Nuba in...and Promethazine to chase it down. I think that is all we carry for pain management. All must be approved by Med Ctrl.

[EMT-P]

Mostly the same for us here in Denton, TX. We use MS, Valium, and Nitrous. We are about to go almost entirely standing orders. This should be interesting.

[Medicman315]

Morphine only, and only for isolated extremity injuries without the possiblilty of multiple systems trauma, no abdominal pain, no back pain, and only by direct orders from ED Doc. Our protocols are county wide, and all meds are chosen by a consortium of all the medical directors from the affiliate hospitals.

[This message has been edited by Medicman315 (edited April 29, 2000).]

[Paramark14]

Here in southern Indiana we have MS, Demerol, Valium, Versed and we also use Norcuron for ET if needed. We'd like to have nitrous.

Mark
EMTP
Indiana

[HossMedic]

I'm sorry to disagree with most of you but I feel you're losing sight of what we're out here to do. "save Lives". I think that we as Paramedics are getting too carried away with the amount of treatment we wish to deliver in the field.

I can't remember the last time a patient died on me because he was in too much pain. The next time you have a patient with a femur Fx. try aplying a simple traction splint. I've seen too many patients breath a sigh of relief once the splint is applied. as for burn patients I would think that airway management and securing an IV for fluid delivery would be of top concern.

I come from a system that uses MS, Valium, Versed, and Ativan. These are all "Life Saving" medications. We do not have pain management protocols. Try to remember to give Nitrates to your cardiac patients before you try to "Manage their pain" with MS.

In my system the Valium, Versed, and Ativan fall into the siezure, concious cardioversion, and concious intubation protocols.

This statement wasn't meant to offend anybody. we're all out here doing a complicated and demanding job. I just think we need to keep it from becoming too complicated. and to leave some work for the emergency departments.

[This message has been edited by HossMedic (edited May 23, 2000).]

[Trauma_Dog]

I agree with the HossMedic's posting and I guess I assumed that all the basic were covered prior to pain management, certainly pain could be reduced by apling ect. However,we only stuck to the basics from day there would be no advances ems. Remember that field defib was at one time a very controversial subject in its day and time. You input is valuable, as even with contrasting points of views produces good solutions.

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Kent Simon
Paramedic Incharge
MCHD EMS,
Montgomery Co.,TX