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Home > List Archives

Opiates & the Acute Abdomen

Andrew J Bowman trauma-list@trauma.org
Sun, 13 Apr 2003 12:20:20 -0500


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I have always had a problem with "pain scales" (whether using 0-10 or =
the Face scale).  I have always charted what the patient has told me =
about their pain and their perceived need for pain medication.  If a =
patient tells me it feels like their insides are being ripped out that =
is what I chart.  Later after pain medication if the patient tells me =
their pain is better and they no longer need pain medication I chart =
that too.  Who cares how their "pain scale" compares to somebody else's. =
 What is important is are they themselves having pain and do they want =
or need something for it (or not).

I find it interesting that the health care person charted a "7" for Dr =
Mattox's "18".  If someone told me 18 I would chart 18.  I am still =
trying to figure out the mathematical formula for converting 18 to 7!!!!

Andrew Bowman
  ----- Original Message -----=20
  From: KMATTOX@aol.com=20
  To: trauma-list@trauma.org=20
  Sent: Sunday, April 13, 2003 12:04 PM
  Subject: Re: Opiates & the Acute Abdomen


  Have any of us (or you) writing about opiates and acute abdominal pain =
ever had abdominal or chest pain and presented as an emergency to a =
physician?  =20

  I would suggest that the withholding of pain medicine to a patient who =
is in severe pain is bordering on being coercive.   Adding a bit of =
tongue in cheek logic, some on this web site are using CT (not history =
or physical examination) to evaluate RLQ pain thought to be =
appendicitis.  If this is the direction the world has gone, then use of =
opiates, sedatives, anesthetics, etc. do not matter, for it is not =
important what is found on the examination as decisions are based on the =
CT. =20

  Pain control is still poorly understood by those controlling the pain. =
  I found in my own case that the chart of the funny faces was =
completely worthless and when I told the questioner that on a scale of =
1-10 my pain level was 18 (and it was), he charted that my response was =
a 7 (wrong).   I also found that the dosing for prn pain (except for the =
PCA pump) was entirely subjective and determined by the philosophies and =
mind set of individual nurses and anesthesiologists.  From shift to =
shift they varied all over the map.=20

  k=20

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<BODY bgColor=3D#ffffff>
<DIV><STRONG><FONT face=3DTahoma size=3D2>I have always had a problem =
with "pain=20
scales" (whether using 0-10 or the Face scale).&nbsp; I have always =
charted what=20
the patient has told me about their pain and their perceived need for =
pain=20
medication.&nbsp; If a patient tells me it feels like their insides are =
being=20
ripped out that is what I chart.&nbsp; Later after pain medication if =
the=20
patient tells me their pain is better and they no longer need pain =
medication I=20
chart that too.&nbsp; Who cares how their "pain scale" compares to =
somebody=20
else's.&nbsp; What is important is are they themselves having pain and =
do they=20
want or need something for it (or not).</FONT></STRONG></DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2></FONT></STRONG>&nbsp;</DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2>I find it interesting that the =
health care=20
person charted a "7" for Dr Mattox's "18".&nbsp; If someone told me 18 I =
would=20
chart 18.&nbsp; I am still trying to figure out the mathematical formula =
for=20
converting 18 to 7!!!!</FONT></STRONG></DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2></FONT></STRONG>&nbsp;</DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2>Andrew =
Bowman</FONT></STRONG></DIV>
<BLOCKQUOTE=20
style=3D"PADDING-RIGHT: 0px; PADDING-LEFT: 5px; MARGIN-LEFT: 5px; =
BORDER-LEFT: #000000 2px solid; MARGIN-RIGHT: 0px">
  <DIV style=3D"FONT: 10pt arial">----- Original Message ----- </DIV>
  <DIV=20
  style=3D"BACKGROUND: #e4e4e4; FONT: 10pt arial; font-color: =
black"><B>From:</B>=20
  <A title=3DKMATTOX@aol.com =
href=3D"mailto:KMATTOX@aol.com">KMATTOX@aol.com</A>=20
  </DIV>
  <DIV style=3D"FONT: 10pt arial"><B>To:</B> <A =
title=3Dtrauma-list@trauma.org=20
  href=3D"mailto:trauma-list@trauma.org">trauma-list@trauma.org</A> =
</DIV>
  <DIV style=3D"FONT: 10pt arial"><B>Sent:</B> Sunday, April 13, 2003 =
12:04=20
  PM</DIV>
  <DIV style=3D"FONT: 10pt arial"><B>Subject:</B> Re: Opiates &amp; the =
Acute=20
  Abdomen</DIV>
  <DIV><BR></DIV><FONT face=3Darial,helvetica><FONT lang=3D0 =
face=3DArial size=3D2=20
  FAMILY=3D"SANSSERIF">Have any of us (or you) writing about opiates and =
acute=20
  abdominal pain ever had abdominal or chest pain and presented as an =
emergency=20
  to a physician?&nbsp;&nbsp; <BR><BR>I would suggest that the =
withholding of=20
  pain medicine to a patient who is in severe pain is bordering on being =

  coercive.&nbsp;&nbsp; Adding a bit of tongue in cheek logic, some on =
this web=20
  site are using CT (not history or physical examination) to evaluate =
RLQ pain=20
  thought to be appendicitis.&nbsp; If this is the direction the world =
has gone,=20
  then use of opiates, sedatives, anesthetics, etc. do not matter, for =
it is not=20
  important what is found on the examination as decisions are based on =
the=20
  CT.&nbsp; <BR><BR>Pain control is still poorly understood by those =
controlling=20
  the pain.&nbsp;&nbsp; I found in my own case that the chart of the =
funny faces=20
  was completely worthless and when I told the questioner that on a =
scale of=20
  1-10 my pain level was 18 (and it was), he charted that my response =
was a 7=20
  (wrong).&nbsp;&nbsp; I also found that the dosing for prn pain (except =
for the=20
  PCA pump) was entirely subjective and determined by the philosophies =
and mind=20
  set of individual nurses and anesthesiologists.&nbsp; From shift to =
shift they=20
  varied all over the map. <BR><BR>k</FONT> =
</FONT></BLOCKQUOTE></BODY></HTML>

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