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Home > List Archives

Opiates & the Acute Abdomen

Holmes John trauma-list@trauma.org
Sun, 13 Apr 2003 11:35:11 +1000


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SCENES FROM THE SPANISH INQUISITION
 
PATIENT:  Moan, gasp, scream,  doc please do something.........
 
ED PHYSICIAN:   Sorry Sport - Dr Sturgeon needs to examine you and see your
pain for himself.
 
PATIENT:  You're kidding, right?  You can see I'm in pain, you heard me
scream when you pushed on my belly....
 
ED PHYSICIAN:   Yeah I know - but Dr Sturgeon needs to ascertain the QUALITY
of your pain for himself.
 
PATIENT:  Oh my God - I can't take too much more of this.  How long will it
be before this other doctor sees me?
 
ED PHYSICIAN:   Well we called him and he's just starting a case in the OR -
perhaps a couple of hours......
 
PATIENT:  Oh my God - moan, weep, sob
 
ED NURSE:  Doctor you've got to do something for this guy
 
ED PHYSICIAN:   Yeah - but you know what Dr Sturgeon is like - needs to
convince himself that the pain is real - remember the gods of surgery don't
listen to mere mortals like you and me. . . . . . . . . . . . . . 
 
 
 
John
 
 
Dr John L Holmes
Director Emergency Medicine
Mater Health Services
Brisbane,  Australia 
 
-----Original Message-----
From: Bjorn, Pret [mailto:pbjorn@emh.org]
Sent: Saturday, 12 April 2003 3:16
To: 'trauma-list@trauma.org'
Subject: RE: Opiates & the Acute Abdomen
 
PATIENT:  Another shot?  What's that stuff?
 
NURSE:  Dr. Sturgeon needs to examine you while you're in pain.  This
medicine shuts off the effects of the morphine we gave you.
 
PATIENT:  You're kidding, right?
 
NURSE:  Sorry, no.  But the good news is, it only costs about twenty bucks.
And it wears off eventually.  You'll be comfortable again in a couple of
hours, tops--unless we have to call in an attending...
 
 
Pret
 
 
-----Original Message-----
From: Richard Buck [  <mailto:teotwawki@sbcglobal.net>
mailto:teotwawki@sbcglobal.net]
Sent: Friday, April 11, 2003 12:30 PM
To: trauma-list@trauma.org
Subject: RE: Opiates & the Acute Abdomen


In my admitted ignorance, I'm puzzled as to why Narcan can't be used to
temporarily negate the effects of narcotic analgesics for the brief period
when a surgeon needs to have the patient's true pain level present to
accurately assess an abdominal injury. Isn't that win/win for patients
who are in pain and must wait for attention (perhaps for hours) yet can
present s/s faithfully to the diagnosing physician during the assessment
(perhaps minutes)? Please educate EMT Trauma educator. My students and I
await enlightenment.

Rich


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<div class=3DSection1>

<p class=3DMsoNormal><font size=3D2 color=3Dmaroon face=3DArial><span =
style=3D'font-size:
10.0pt;font-family:Arial;color:maroon'>SCENES FROM THE SPANISH =
INQUISITION<o:p></o:p></span></font></p>

<p class=3DMsoNormal><font size=3D2 color=3Dmaroon face=3DArial><span =
style=3D'font-size:
10.0pt;font-family:Arial;color:maroon'><![if =
!supportEmptyParas]>&nbsp;<![endif]><o:p></o:p></span></font></p>

<p class=3DMsoNormal><font size=3D2 color=3Dmaroon face=3DArial><span =
style=3D'font-size:
10.0pt;font-family:Arial;color:maroon'>PATIENT:&nbsp; Moan, gasp, =
scream, <span
style=3D"mso-spacerun: yes">&nbsp;</span>doc please do =
something&#8230;&#8230;&#8230;</span></font><font
color=3Dmaroon><span =
style=3D'color:maroon;mso-color-alt:windowtext'><o:p></o:p></span></font=
></p>

<p class=3DMsoNormal><font size=3D3 color=3Dmaroon face=3D"Times New =
Roman"><span
style=3D'font-size:12.0pt;color:maroon'>&nbsp;</span></font><font =
color=3Dmaroon><span
style=3D'color:maroon;mso-color-alt:windowtext'><o:p></o:p></span></font=
></p>

<p class=3DMsoNormal><font size=3D2 color=3Dmaroon face=3DArial><span =
style=3D'font-size:
10.0pt;font-family:Arial;color:maroon'>ED PHYSICIAN:&nbsp; <span
style=3D"mso-spacerun: yes">&nbsp;</span>Sorry Sport &#8211; Dr =
Sturgeon needs to
examine you and see your pain for himself.<o:p></o:p></span></font></p>

<p class=3DMsoNormal><font size=3D2 color=3Dmaroon face=3DArial><span =
style=3D'font-size:
10.0pt;font-family:Arial;color:maroon'><![if !supportEmptyParas]>&nbsp;<=
![endif]><o:p></o:p></span></font></p>

<p class=3DMsoNormal><font size=3D2 color=3Dmaroon face=3DArial><span =
style=3D'font-size:
10.0pt;font-family:Arial;color:maroon'>PATIENT:&nbsp; You're kidding, =
right? <span
style=3D"mso-spacerun: yes">&nbsp;</span>You can see I&#8217;m in pain, =
you heard me scream
when you pushed on my belly&#8230;.<o:p></o:p></span></font></p>

<p class=3DMsoNormal><font size=3D2 color=3Dmaroon face=3DArial><span =
style=3D'font-size:
10.0pt;font-family:Arial;color:maroon'><![if =
!supportEmptyParas]>&nbsp;<![endif]><o:p></o:p></span></font></p>

<p class=3DMsoNormal><font size=3D2 color=3Dmaroon face=3DArial><span =
style=3D'font-size:
10.0pt;font-family:Arial;color:maroon'>ED PHYSICIAN:&nbsp; <span
style=3D"mso-spacerun: yes">&nbsp;</span>Yeah I know &#8211; but Dr =
Sturgeon needs to ascertain
the QUALITY of your pain for himself.<o:p></o:p></span></font></p>

<p class=3DMsoNormal><font size=3D2 color=3Dmaroon face=3DArial><span =
style=3D'font-size:
10.0pt;font-family:Arial;color:maroon'><![if =
!supportEmptyParas]>&nbsp;<![endif]><o:p></o:p></span></font></p>

<p class=3DMsoNormal><font size=3D2 color=3Dmaroon face=3DArial><span =
style=3D'font-size:
10.0pt;font-family:Arial;color:maroon'>PATIENT:&nbsp; Oh my God &#8211; =
I can&#8217;t take too
much more of this. <span style=3D"mso-spacerun: yes">&nbsp;</span>How =
long will it
be before this other doctor sees me?<o:p></o:p></span></font></p>

<p class=3DMsoNormal><font size=3D2 color=3Dmaroon face=3DArial><span =
style=3D'font-size:
10.0pt;font-family:Arial;color:maroon'><![if =
!supportEmptyParas]>&nbsp;<![endif]><o:p></o:p></span></font></p>

<p class=3DMsoNormal><font size=3D2 color=3Dmaroon face=3DArial><span =
style=3D'font-size:
10.0pt;font-family:Arial;color:maroon'>ED PHYSICIAN:&nbsp; <span
style=3D"mso-spacerun: yes">&nbsp;</span>Well we called him and =
he&#8217;s just starting
a case in the OR &#8211; perhaps a couple of =
hours&#8230;&#8230;<o:p></o:p></span></font></p>

<p class=3DMsoNormal><font size=3D2 color=3Dmaroon face=3DArial><span =
style=3D'font-size:
10.0pt;font-family:Arial;color:maroon'><![if =
!supportEmptyParas]>&nbsp;<![endif]><o:p></o:p></span></font></p>

<p class=3DMsoNormal><font size=3D2 color=3Dmaroon face=3DArial><span =
style=3D'font-size:
10.0pt;font-family:Arial;color:maroon'>PATIENT:&nbsp; Oh my God &#8211; =
moan, weep, sob<o:p></o:p></span></font></p>

<p class=3DMsoNormal><font size=3D2 color=3Dmaroon face=3DArial><span =
style=3D'font-size:
10.0pt;font-family:Arial;color:maroon'><![if =
!supportEmptyParas]>&nbsp;<![endif]><o:p></o:p></span></font></p>

<p class=3DMsoNormal><font size=3D2 color=3Dmaroon face=3DArial><span =
style=3D'font-size:
10.0pt;font-family:Arial;color:maroon'>ED NURSE: <span =
style=3D"mso-spacerun:
yes">&nbsp;</span>Doctor you&#8217;ve got to do something for this =
guy<o:p></o:p></span></font></p>

<p class=3DMsoNormal><font size=3D2 color=3Dmaroon face=3DArial><span =
style=3D'font-size:
10.0pt;font-family:Arial;color:maroon'><![if =
!supportEmptyParas]>&nbsp;<![endif]><o:p></o:p></span></font></p>

<p class=3DMsoNormal><font size=3D2 color=3Dmaroon face=3DArial><span =
style=3D'font-size:
10.0pt;font-family:Arial;color:maroon'>ED PHYSICIAN:&nbsp; <span
style=3D"mso-spacerun: yes">&nbsp;</span>Yeah &#8211; but you know what =
Dr Sturgeon is like
&#8211; needs to convince himself that the pain is real &#8211; =
remember the gods of surgery
don&#8217;t listen to mere mortals like you and me. . . . . . . . . . . =
. . . <o:p></o:p></span></font></p>

<p class=3DMsoNormal><font size=3D2 color=3Dmaroon face=3DArial><span =
style=3D'font-size:
10.0pt;font-family:Arial;color:maroon'><![if =
!supportEmptyParas]>&nbsp;<![endif]><o:p></o:p></span></font></p>

<p class=3DMsoNormal><span class=3DEmailStyle17><font size=3D3 =
color=3Dmaroon
face=3DArial><span style=3D'font-size:12.0pt;font-family:Arial'><![if =
!supportEmptyParas]>&nbsp;<![endif]><o:p></o:p></span></font></span></p>=


<p class=3DMsoNormal><span class=3DEmailStyle17><font size=3D3 =
color=3Dmaroon
face=3DArial><span style=3D'font-size:12.0pt;font-family:Arial'><![if =
!supportEmptyParas]>&nbsp;<![endif]><o:p></o:p></span></font></span></p>=


<p class=3DMsoNormal><span class=3DEmailStyle17><font size=3D3 =
color=3Dmaroon
face=3DArial><span =
style=3D'font-size:12.0pt;font-family:Arial'>John<o:p></o:p></span></fon=
t></span></p>

<p class=3DMsoNormal><span class=3DEmailStyle17><font size=3D3 =
color=3Dmaroon
face=3DArial><span style=3D'font-size:12.0pt;font-family:Arial'><![if =
!supportEmptyParas]>&nbsp;<![endif]><o:p></o:p></span></font></span></p>=


<p class=3DMsoNormal><span class=3DEmailStyle17><font size=3D3 =
color=3Dmaroon
face=3DArial><span style=3D'font-size:12.0pt;font-family:Arial'><![if =
!supportEmptyParas]>&nbsp;<![endif]><o:p></o:p></span></font></span></p>=


<p class=3DMsoAutoSig><!--[if supportFields]><span =
class=3DEmailStyle17><font=20
color=3Dmaroon face=3DArial><span style=3D'font-family:Arial'><span =
style=3D'mso-element:
field-begin'></span><span style=3D"mso-spacerun: =
yes">&nbsp;</span>AUTOTEXTLIST=20
\s &quot;E-mail Signature&quot; <span =
style=3D'mso-element:field-separator'></span></span></font></span><![end=
if]--><b><font
color=3Dblue face=3DArial><span =
style=3D'font-family:Arial;color:blue;font-weight:
bold'>Dr John L Holmes<o:p></o:p></span></font></b></p>

<p class=3DMsoAutoSig><font size=3D3 color=3Dblue face=3DArial><span =
style=3D'font-size:
12.0pt;font-family:Arial;color:blue'>Director Emergency =
Medicine<o:p></o:p></span></font></p>

<p class=3DMsoAutoSig><font size=3D3 color=3Dblue face=3DArial><span =
style=3D'font-size:
12.0pt;font-family:Arial;color:blue'>Mater Health =
Services<o:p></o:p></span></font></p>

<p class=3DMsoAutoSig><font size=3D3 color=3Dblue face=3DArial><span =
style=3D'font-size:
12.0pt;font-family:Arial;color:blue'>Brisbane,<span =
style=3D"mso-spacerun:
yes">&nbsp; </span>Australia <o:p></o:p></span></font></p>

<p class=3DMsoNormal><!--[if supportFields]><span =
class=3DEmailStyle17><font=20
color=3Dmaroon face=3DArial><span style=3D'font-family:Arial'><span =
style=3D'mso-element:
field-end'></span></span></font></span><![endif]--><span =
class=3DEmailStyle17><font
color=3Dmaroon face=3DArial><span style=3D'font-family:Arial'><![if =
!supportEmptyParas]>&nbsp;<![endif]><o:p></o:p></span></font></span></p>=


<p class=3DMsoNormal style=3D'margin-left:36.0pt'><font size=3D2 =
color=3Dblack
face=3DTahoma><span =
style=3D'font-size:10.0pt;font-family:Tahoma;color:black'>-----Original
Message-----<br>
<b><span style=3D'font-weight:bold'>From:</span></b> Bjorn, Pret
[mailto:pbjorn@emh.org]<br>
<b><span style=3D'font-weight:bold'>Sent:</span></b> Saturday, 12 April =
2003 3:16<br>
<b><span style=3D'font-weight:bold'>To:</span></b> =
'trauma-list@trauma.org'<br>
<b><span style=3D'font-weight:bold'>Subject:</span></b> RE: Opiates =
&amp; the
Acute Abdomen</span></font></p>

<p class=3DMsoNormal style=3D'margin-left:36.0pt'><font size=3D3
face=3D"Times New Roman"><span style=3D'font-size:12.0pt'><![if =
!supportEmptyParas]>&nbsp;<![endif]><o:p></o:p></span></font></p>

<p class=3DMsoNormal style=3D'margin-left:36.0pt'><font size=3D2 =
color=3Dmaroon
face=3DArial><span =
style=3D'font-size:10.0pt;font-family:Arial;color:maroon'>PATIENT:&nbsp;=

Another shot?&nbsp; What's that stuff?</span></font><font =
color=3Dblack><span
style=3D'color:black;mso-color-alt:windowtext'><o:p></o:p></span></font>=
</p>

<p class=3DMsoNormal style=3D'margin-left:36.0pt'><font size=3D3 =
color=3Dblack
face=3D"Times New Roman"><span =
style=3D'font-size:12.0pt;color:black'>&nbsp;</span></font><font
color=3Dblack><span =
style=3D'color:black;mso-color-alt:windowtext'><o:p></o:p></span></font>=
</p>

<p class=3DMsoNormal style=3D'margin-left:36.0pt'><font size=3D2 =
color=3Dmaroon
face=3DArial><span =
style=3D'font-size:10.0pt;font-family:Arial;color:maroon'>NURSE:&nbsp;
Dr. Sturgeon needs to examine you while you're in pain.&nbsp; This =
medicine
shuts off the effects of the morphine we gave you.</span></font><font
color=3Dblack><span =
style=3D'color:black;mso-color-alt:windowtext'><o:p></o:p></span></font>=
</p>

<p class=3DMsoNormal style=3D'margin-left:36.0pt'><font size=3D3 =
color=3Dblack
face=3D"Times New Roman"><span =
style=3D'font-size:12.0pt;color:black'>&nbsp;</span></font><font
color=3Dblack><span =
style=3D'color:black;mso-color-alt:windowtext'><o:p></o:p></span></font>=
</p>

<p class=3DMsoNormal style=3D'margin-left:36.0pt'><font size=3D2 =
color=3Dmaroon
face=3DArial><span =
style=3D'font-size:10.0pt;font-family:Arial;color:maroon'>PATIENT:&nbsp;=

You're kidding, right?</span></font><font color=3Dblack><span =
style=3D'color:black;
mso-color-alt:windowtext'><o:p></o:p></span></font></p>

<p class=3DMsoNormal style=3D'margin-left:36.0pt'><font size=3D3 =
color=3Dblack
face=3D"Times New Roman"><span =
style=3D'font-size:12.0pt;color:black'>&nbsp;</span></font><font
color=3Dblack><span =
style=3D'color:black;mso-color-alt:windowtext'><o:p></o:p></span></font>=
</p>

<p class=3DMsoNormal style=3D'margin-left:36.0pt'><font size=3D2 =
color=3Dmaroon
face=3DArial><span =
style=3D'font-size:10.0pt;font-family:Arial;color:maroon'>NURSE:&nbsp;
Sorry, no.&nbsp; But the good news is, it only costs about twenty =
bucks.&nbsp;
And it wears off eventually.&nbsp; You'll be comfortable again in a =
couple of
hours, tops--unless we have to call in an =
attending...</span></font><font
color=3Dblack><span =
style=3D'color:black;mso-color-alt:windowtext'><o:p></o:p></span></font>=
</p>

<p class=3DMsoNormal style=3D'margin-left:36.0pt'><font size=3D3 =
color=3Dblack
face=3D"Times New Roman"><span =
style=3D'font-size:12.0pt;color:black'>&nbsp;</span></font><font
color=3Dblack><span =
style=3D'color:black;mso-color-alt:windowtext'><o:p></o:p></span></font>=
</p>

<p class=3DMsoNormal style=3D'margin-left:36.0pt'><font size=3D3 =
color=3Dblack
face=3D"Times New Roman"><span =
style=3D'font-size:12.0pt;color:black'>&nbsp;</span></font><font
color=3Dblack><span =
style=3D'color:black;mso-color-alt:windowtext'><o:p></o:p></span></font>=
</p>

<p class=3DMsoNormal style=3D'margin-left:36.0pt'><font size=3D2 =
color=3Dmaroon
face=3DArial><span =
style=3D'font-size:10.0pt;font-family:Arial;color:maroon'>Pret</span></f=
ont><font
color=3Dblack><span =
style=3D'color:black;mso-color-alt:windowtext'><o:p></o:p></span></font>=
</p>

<p class=3DMsoNormal style=3D'margin-left:36.0pt'><font size=3D3 =
color=3Dblack
face=3D"Times New Roman"><span =
style=3D'font-size:12.0pt;color:black'>&nbsp;</span></font><font
color=3Dblack><span =
style=3D'color:black;mso-color-alt:windowtext'><o:p></o:p></span></font>=
</p>

<p class=3DMsoNormal style=3D'margin-left:36.0pt'><font size=3D3 =
color=3Dblack
face=3D"Times New Roman"><span =
style=3D'font-size:12.0pt;color:black'>&nbsp;</span></font><font
color=3Dblack><span =
style=3D'color:black;mso-color-alt:windowtext'><o:p></o:p></span></font>=
</p>

<p class=3DMsoNormal style=3D'margin-left:36.0pt'><font size=3D2 =
color=3Dblack
face=3DArial><span =
style=3D'font-size:10.0pt;font-family:Arial;color:black'>-----Original
Message-----<br>
From: Richard Buck [</span></font><font color=3Dblack><span =
style=3D'color:black'><a
href=3D"mailto:teotwawki@sbcglobal.net"><font size=3D2 color=3Dblack =
face=3DArial><span
style=3D'font-size:10.0pt;font-family:Arial;color:black'>mailto:teotwawk=
i@sbcglobal.net</span></font></a></span></font><font
size=3D2 color=3Dblack face=3DArial><span =
style=3D'font-size:10.0pt;font-family:Arial;
color:black'>]<br>
Sent: Friday, April 11, 2003 12:30 PM<br>
To: trauma-list@trauma.org<br>
Subject: RE: Opiates &amp; the Acute Abdomen<br>
<br>
<br>
In my admitted ignorance, I'm puzzled as to why Narcan can't be used =
to<br>
temporarily negate the effects of narcotic analgesics for the brief =
period<br>
when a surgeon needs to have the patient's true pain level present =
to<br>
accurately assess an abdominal injury. Isn't that win/win for =
patients<br>
who are in pain and must wait for attention (perhaps for hours) yet =
can<br>
present s/s faithfully to the diagnosing physician during the =
assessment<br>
(perhaps minutes)? Please educate EMT Trauma educator. My students and =
I<br>
await enlightenment.<br>
<br>
Rich<br>
<br>
<br>
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