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Thu, 10 Apr 2003 18:52:44 EDT

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In a message dated 4/10/2003 6:04:34 PM Eastern Daylight Time, 
cmursic@yahoo.com writes:

> numbers of patients we are asked to see by the ER
> service who did not initially meet full trauma
> activation criteria yet in whom there is a question of
> intraabdominal injury.  I plan to show this paper to
> our Director of Emergency Medicine, who is a staunch
> advocate of pre-surgical consult narcomedication.  I'd
> be interested in everybody's thoughts as well

I myself, as a contribution from purely my own anecdotal experience, have 
never found  reasonable parenteral analgesia to mask surgically significant 
abdominal pain nor to at all impair my ability to make a decision--nor in 
retrospect to have ever felt that it led me to the wrong decision.  My take 
on some of this is that if it takes surgeons an unreasonable length of time 
to come down to evaluate a patient with pain, this becomes a real and valid 
issue for ER docs, and I beleive that is what drives continued investigation 
of this question.  If there is a policy, as there is with us, that ANY call 
from the ER gets seen within 30 minutes, it is a non-issue--they are willing 
to wait, and if the patient is in significant discomfort, they will ask--and 
I do not have a problem with their use of such.  I prefer non-narcotcs as a 
first try, such as Toradol, and our guys have no problem with this.
Those who see this as a problem, ask yourselves honestly if the real problem  
more involves a frictioned relationship between the services or delayed 
response to consults than the question you posed.
BTW--there is more than Er literature supporting the non-effect of analgisics 
on the evaluation for abdominal pain--there is also support in the surgical 
literature, written by surgeons, for this as well--I will try to look it up, 
from a few years ago.
ERF

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<HTML><FONT FACE=3Darial,helvetica><FONT  SIZE=3D2 FAMILY=3D"SANSSERIF" FACE=
=3D"Arial" LANG=3D"0">In a message dated 4/10/2003 6:04:34 PM Eastern Daylig=
ht Time, cmursic@yahoo.com writes:<BR>
<BR>
<BLOCKQUOTE TYPE=3DCITE style=3D"BORDER-LEFT: #0000ff 2px solid; MARGIN-LEFT=
: 5px; MARGIN-RIGHT: 0px; PADDING-LEFT: 5px">numbers of patients we are aske=
d to see by the ER<BR>
service who did not initially meet full trauma<BR>
activation criteria yet in whom there is a question of<BR>
intraabdominal injury.&nbsp; I plan to show this paper to<BR>
our Director of Emergency Medicine, who is a staunch<BR>
advocate of pre-surgical consult narcomedication.&nbsp; I'd<BR>
be interested in everybody's thoughts as well</BLOCKQUOTE></FONT><FONT  COLO=
R=3D"#000000" style=3D"BACKGROUND-COLOR: #ffffff" SIZE=3D2 FAMILY=3D"SANSSER=
IF" FACE=3D"Arial" LANG=3D"0"><BR>
<BR>
</FONT><FONT  COLOR=3D"#000000" style=3D"BACKGROUND-COLOR: #ffffff" SIZE=3D2=
 FAMILY=3D"SANSSERIF" FACE=3D"Arial" LANG=3D"0">I myself, as a contribution=20=
from purely my own anecdotal experience, have never found&nbsp; reasonable p=
arenteral analgesia to mask surgically significant abdominal pain nor to at=20=
all impair my ability to make a decision--nor in retrospect to have ever fel=
t that it led me to the wrong decision.&nbsp; My take on some of this is tha=
t if it takes surgeons an unreasonable length of time to come down to evalua=
te a patient with pain, this becomes a real and valid issue for ER docs, and=
 I beleive that is what drives continued investigation of this question.&nbs=
p; If there is a policy, as there is with us, that ANY call from the ER gets=
 seen within 30 minutes, it is a non-issue--they are willing to wait, and if=
 the patient is in significant discomfort, they will ask--and I do not have=20=
a problem with their use of such.&nbsp; I prefer non-narcotcs as a first try=
, such as Toradol, and our guys have no problem with this.<BR>
Those who see this as a problem, ask yourselves honestly if the real problem=
&nbsp; more involves a frictioned relationship between the services or delay=
ed response to consults than the question you posed.<BR>
BTW--there is more than Er literature supporting the non-effect of analgisic=
s on the evaluation for abdominal pain--there is also support in the surgica=
l literature, written by surgeons, for this as well--I will try to look it u=
p, from a few years ago.<BR>
ERF<BR>
<BR>
</FONT></HTML>
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