Login
Site Search
Trauma-List Subscription

Subscribe

Would you like to receive list emails batched into one daily digest?
No Yes
Modify Your Subscription

Modify

Home > List Archives

pain and suffering

Nick Nudell trauma-list@trauma.org
Sat, 12 Apr 2003 17:01:55 -0700


This is a multi-part message in MIME format.

--Boundary_(ID_HJ/br3CsIL2aaabFx+0maQ)
Content-type: text/plain; charset=iso-8859-1
Content-transfer-encoding: 7BIT

Andrew

The purpose of protocols is to remove the 'borderline vitals' factors so that standardized treatment may be provided. Either the BP was over 100 or under it (or whatever the particular vital you are speaking about).

I have not seen 10mg of MS IV do horrible things to vitals... no, I see pain causing sympathetic rises in vitals which are then mediated by the removal of the pain. They are not hypotensive because of the MS but because of the lack of pain. As for altered, if you do a proper assessment you should be able to determine if the patient is altered. Does it matter if the altered has come from the MS or a head injury? The fact the patient is altered is only ONE of many signs/symptoms that would be used to diagnose a head injury, so really that is a moot point.

I am a paramedic, I DO practice medicine, under the delegated practice of my medical director. If you have a problem with the treatment provided by your local paramedics, I would suggest that you document the problem, provide some evidence for your problem and approach the medical director who has approved the protocols that you have the problem with. Period. End of Story.

Nick


____________________________________________
Nick Nudell, NREMT-P, CCEMT-P
California
nudell@prehospital-perspective.com

"Perception is reality" - Wise Old Paramedic




  ----- Original Message ----- 
  From: Andrew J Bowman 
  To: trauma-list@trauma.org 
  Sent: Saturday, April 12, 2003 6:38 AM
  Subject: Re: pain and suffering


  I have no problem with medics making decisions, they make sound ones everyday.  I have a problem with medics who break protocol (just like I have a problem with nurses who break protocol).  The problem I describe is a multisystem trauma patient with borderline vitals who gets 10mg of MS IV.

  Then when they hit the ER, are they altered because of the MS or brain injury?  Are they hypotensive because of the MS or bleeding?

  Medics do great job, but they should not be practicing medicine, if they feel a patient would benefit from an intervention that is not covered by their protocol then that is why they have radios and cell phones, to call in and discuss/request from the ED physician getting the patient.

  Andrew
    ----- Original Message ----- 
    From: michael riordan 
    To: trauma-list@trauma.org 
    Sent: Saturday, April 12, 2003 1:32 AM
    Subject: pain and suffering


    Andrew,

     I seem to recall you posted a like thread like this before. You seem to have a problem with paramedics making a decision. Do you think every trauma patient in the field will become hypotensive after morphine is given? Or is it that it only happens with paramedics? 

    Luckily in Australia we dont have such regressive thinking. IC paras dont need to consult. We would more likely get strange looks at the ED if we took a patient into hospital in pain (from whatever) that should have been reduced.  

    What is wrong with giving morphine to a patient in pain? Especially from trauma. Especially in outlying areas. You would prefer some one to be in pain until the hospital? I cannot fathom the logic. 

    Michael

--Boundary_(ID_HJ/br3CsIL2aaabFx+0maQ)
Content-type: text/html; charset=iso-8859-1
Content-transfer-encoding: 7BIT

<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN">
<HTML><HEAD>
<META http-equiv=Content-Type content="text/html; charset=iso-8859-1">
<META content="MSHTML 6.00.2800.1106" name=GENERATOR>
<STYLE></STYLE>
</HEAD>
<BODY style="COLOR: #000000; FONT-FAMILY: Tahoma" bgColor=#ffffff>
<DIV><FONT size=2>Andrew</FONT></DIV>
<DIV><FONT size=2></FONT>&nbsp;</DIV>
<DIV><FONT size=2>The purpose of protocols is to remove the 'borderline vitals' 
factors so that standardized treatment may be provided. Either the BP was over 
100 or under it (or whatever the particular vital you are speaking 
about).</FONT></DIV>
<DIV><FONT size=2></FONT>&nbsp;</DIV>
<DIV><FONT size=2>I have not seen 10mg of MS IV do horrible things to vitals... 
no, I see pain causing sympathetic rises in vitals which are then mediated by 
the removal of the pain. They are not hypotensive because of the MS but because 
of the lack of pain. As for altered, if you do a proper assessment you should be 
able to determine if the patient is altered. Does it matter if the altered has 
come from the MS or a head injury? The fact the patient is altered is only ONE 
of many signs/symptoms that would be used to diagnose a head injury, so really 
that is a moot point.</FONT></DIV>
<DIV><FONT size=2></FONT>&nbsp;</DIV>
<DIV><FONT size=2>I am a paramedic, I DO practice medicine, under the delegated 
practice of my medical director. If you have a problem with the treatment 
provided by your local paramedics, I would suggest that you document the 
problem, provide some evidence for your problem and approach the medical 
director who has approved the protocols that you have the problem with. Period. 
End of Story.</FONT></DIV>
<DIV><FONT size=2></FONT>&nbsp;</DIV>
<DIV><FONT size=2>Nick</FONT></DIV>
<DIV><FONT size=2></FONT>&nbsp;</DIV>
<DIV><BR><FONT size=2>____________________________________________<BR>Nick 
Nudell, NREMT-P, CCEMT-P<BR>California<BR></FONT><A 
href="mailto:nudell@prehospital-perspective.com"><FONT 
size=2>nudell@prehospital-perspective.com</FONT></A></DIV>
<DIV><FONT size=2></FONT>&nbsp;</DIV>
<DIV><FONT size=2>"Perception is reality" - Wise Old Paramedic</FONT></DIV>
<DIV><FONT size=2></FONT>&nbsp;</DIV>
<DIV><FONT size=2></FONT>&nbsp;</DIV>
<DIV>&nbsp;</DIV>
<DIV>&nbsp;</DIV>
<BLOCKQUOTE dir=ltr 
style="PADDING-RIGHT: 0px; PADDING-LEFT: 5px; MARGIN-LEFT: 5px; BORDER-LEFT: #000000 2px solid; MARGIN-RIGHT: 0px">
  <DIV style="FONT: 10pt arial">----- Original Message ----- </DIV>
  <DIV 
  style="BACKGROUND: #e4e4e4; FONT: 10pt arial; font-color: black"><B>From:</B> 
  <A title=sumieb@compuserve.com href="mailto:sumieb@compuserve.com">Andrew J 
  Bowman</A> </DIV>
  <DIV style="FONT: 10pt arial"><B>To:</B> <A title=trauma-list@trauma.org 
  href="mailto:trauma-list@trauma.org">trauma-list@trauma.org</A> </DIV>
  <DIV style="FONT: 10pt arial"><B>Sent:</B> Saturday, April 12, 2003 6:38 
  AM</DIV>
  <DIV style="FONT: 10pt arial"><B>Subject:</B> Re: pain and suffering</DIV>
  <DIV><BR></DIV>
  <DIV><STRONG><FONT face=Tahoma size=2>I have no problem with medics making 
  decisions, they make sound ones everyday.&nbsp; I have a problem with medics 
  who break protocol (just like I have a problem with nurses who break 
  protocol).&nbsp; The problem I describe is a multisystem trauma patient with 
  borderline vitals who gets 10mg of MS IV.</FONT></STRONG></DIV>
  <DIV><STRONG><FONT face=Tahoma size=2></FONT></STRONG>&nbsp;</DIV>
  <DIV><STRONG><FONT face=Tahoma size=2>Then when they hit the ER, are they 
  altered because of the MS or brain injury?&nbsp; Are they hypotensive because 
  of the MS or bleeding?</FONT></STRONG></DIV>
  <DIV><STRONG><FONT face=Tahoma size=2></FONT></STRONG>&nbsp;</DIV>
  <DIV><STRONG><FONT face=Tahoma size=2>Medics do great job, but they should not 
  be practicing medicine, if they feel a patient would benefit from an 
  intervention that is not covered by their protocol then that is why they have 
  radios and cell phones, to call in and discuss/request from the ED physician 
  getting the patient.</FONT></STRONG></DIV>
  <DIV><STRONG><FONT face=Tahoma size=2></FONT></STRONG>&nbsp;</DIV>
  <DIV><STRONG><FONT face=Tahoma size=2>Andrew</FONT></STRONG></DIV>
  <BLOCKQUOTE dir=ltr 
  style="PADDING-RIGHT: 0px; PADDING-LEFT: 5px; MARGIN-LEFT: 5px; BORDER-LEFT: #000000 2px solid; MARGIN-RIGHT: 0px">
    <DIV style="FONT: 10pt arial">----- Original Message ----- </DIV>
    <DIV 
    style="BACKGROUND: #e4e4e4; FONT: 10pt arial; font-color: black"><B>From:</B> 
    <A title=riordanms@optusnet.com.au 
    href="mailto:riordanms@optusnet.com.au">michael riordan</A> </DIV>
    <DIV style="FONT: 10pt arial"><B>To:</B> <A title=trauma-list@trauma.org 
    href="mailto:trauma-list@trauma.org">trauma-list@trauma.org</A> </DIV>
    <DIV style="FONT: 10pt arial"><B>Sent:</B> Saturday, April 12, 2003 1:32 
    AM</DIV>
    <DIV style="FONT: 10pt arial"><B>Subject:</B> pain and suffering</DIV>
    <DIV><BR></DIV>
    <DIV><FONT face=Arial size=2>Andrew,</FONT></DIV>
    <DIV>&nbsp;</DIV>
    <DIV><FONT face=Arial size=2>&nbsp;I seem to recall you&nbsp;posted a like 
    thread like this before. You seem to have a problem with paramedics making a 
    decision.&nbsp;Do you&nbsp;think every trauma patient in the field will 
    become hypotensive after morphine is given? Or is it that it only happens 
    with paramedics? </FONT></DIV>
    <DIV><FONT face=Arial size=2></FONT>&nbsp;</DIV>
    <DIV><FONT face=Arial size=2>Luckily in Australia we dont have such 
    regressive thinking. IC paras dont need to consult. We would more likely get 
    strange looks at the ED if we took a patient into hospital in pain (from 
    whatever) that should have been reduced.&nbsp; </FONT></DIV>
    <DIV>&nbsp;</DIV>
    <DIV><FONT face=Arial size=2>What is wrong with giving morphine to a patient 
    in pain? Especially from trauma. Especially in outlying areas. You would 
    prefer some one to be in pain until the hospital? I cannot fathom the logic. 
    </FONT></DIV>
    <DIV>&nbsp;</DIV>
    <DIV><FONT face=Arial 
size=2>Michael</FONT></DIV></BLOCKQUOTE></BLOCKQUOTE></BODY></HTML>

--Boundary_(ID_HJ/br3CsIL2aaabFx+0maQ)--