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Fri, 11 Apr 2003 08:47:09 +0100

This appears to be the fundamental problem. Use of morphine is equated =
to narcosis which may impair clinical assessment.=20

The truth is elsewhere. Opiate is the best analgesia which CAN well be =
achieved WITHOUT narcosis. Perfect analgesia is good for assessment, =
physiologically sound, humane and causes NO confusion - for trauma and =
anything else.=20

This is my experience since 1984.
Aruni Sen
MS FRCS FFAEM
Consultant in Emergency Medicine
Maelor Hospital; North East Wales NHS Trust
Wrexham LL13 7TD, UK.
Tel 01978 725555 / 725498 (secy)
Fax 01978 725168
Mobile 07931 542759 ; Pager 07625 618656
Email : aruni.sen@new-tr.wales.nhs.uk

	-----Original Message-----
	From:	Andrew J Bowman [SMTP:sumieb@compuserve.com]
	Sent:	Friday, April 11, 2003 1:56 AM
	To:	trauma-list@trauma.org
	Subject:	Re: Opiates & the Acute Abdomen

	What really is a problem in my community is outlying ALS services
	administering narcotics to multi-trauma patients (not just isolated
	extremity injury) without calling the ED physician based on their "pain
	management protocol" which is designed only for the isolated extremity
	injury (cannot get their medical director to emphasize the potential
	"badness" of this practice (which I feel is "practicing medicine w/o a
	license")

	Andrew J. Bowman, RN, CEN, CCRN, NREMT-P
	Patient Care Coordinator
	Education Coordinator (Trauma & Emergency Cardiovascular Care)
	Emergency Department
	Home Hospital Campus
	Greater Lafayette Health Services, Inc.
	2400 South Street
	Lafayette, Indiana  47904
	----- Original Message -----
	From: "caesar ursic" <cmursic@yahoo.com>
	To: <trauma-list@trauma.org>
	Sent: Thursday, April 10, 2003 4:35 PM
	Subject: Opiates & the Acute Abdomen

	>
	> This month's lead article in the American Journal of
	> Surgery (Nissman SA, Kaplan LJ, Mann BD. Critically
	> reappraising the literature-driven practice of
	> analgesia administration for acute abdominal pain in
	> the emergency room prior to surgical evaluation. Am J
	> Surg 2003;185:291-96) addresses the once (still?)
	> controversial practice of administering narcotics to
	> patients suspected of harboring intraabdominal
	> pathology before the arrival of the consulting
	> surgeon.  I know this issue has been discussed on this
	> board before, but these authors present a nice
	> critique of the very same literature that is often
	> quoted (mainly by Emergency medicine doctors, in my
	> experience) to support this practice.  At best the
	> supporting evidence comes from four studies that were
	> flawed in design and/or examined insufficient numbers
	> of patients.  Based on my reading of the paper, it
	> seems that surgeons who still get upset when they are
	> asked to see a patient with a possible surgical
	> abdomen who has already been narcotized should not be
	> dismissed as crusty curmudgeons who fail to adapt to
	> the times or who are ignorant of the latest
	> "literature."  Has this practice, then, become the
	> "standard of care" without a sufficient body of
	> supporting evidence?  I believe this is a relevant
	> issue in trauma care as well, given the significant
	> 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.
	>
	> C.M. Ursic, M.D.
	> Dept. of Surgery
	> UCSF-East Bay
	> Oakland, California
	>
	>
	>
	>
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