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pain and suffering
Nick Nudell trauma-list@trauma.orgSat, 12 Apr 2003 17:01:55 -0700
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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> </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> </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> </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> </DIV> <DIV><FONT size=2>Nick</FONT></DIV> <DIV><FONT size=2></FONT> </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> </DIV> <DIV><FONT size=2>"Perception is reality" - Wise Old Paramedic</FONT></DIV> <DIV><FONT size=2></FONT> </DIV> <DIV><FONT size=2></FONT> </DIV> <DIV> </DIV> <DIV> </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. 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.</FONT></STRONG></DIV> <DIV><STRONG><FONT face=Tahoma size=2></FONT></STRONG> </DIV> <DIV><STRONG><FONT face=Tahoma size=2>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?</FONT></STRONG></DIV> <DIV><STRONG><FONT face=Tahoma size=2></FONT></STRONG> </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> </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> </DIV> <DIV><FONT face=Arial size=2> 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? </FONT></DIV> <DIV><FONT face=Arial size=2></FONT> </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. </FONT></DIV> <DIV> </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> </DIV> <DIV><FONT face=Arial size=2>Michael</FONT></DIV></BLOCKQUOTE></BLOCKQUOTE></BODY></HTML> --Boundary_(ID_HJ/br3CsIL2aaabFx+0maQ)--
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