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pain and suffering
Andrew J Bowman trauma-list@trauma.orgSun, 13 Apr 2003 13:23:12 -0500
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This is a multi-part message in MIME format. ------=_NextPart_000_00ED_01C301BF.D52D4140 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Nick, Thanks for your feedback. The "pain management" protocol used by the = outlying service in question allows for titrated morphine for the = treatment of ISOLATED extremity injury. It is clearly stated as such IN = the protocol. However, we still receive patients who have received 10mg = or more of MS for their multi-system trauma. Their medical director has = been informed but nothing has changed. Yes, altered LOC is one of many s/s of head injury. But if the patient = was alert before and now is altered after MS, is it JUST the MS or an = expanding lesion, or brain ischemia, or hypoxia??? By the way, you practice paramedicine under the your medical director, = just like I practice nursing and paramedicine (I am a paramedic and a = nurse) in my respective environments. To practice medicine requires an = MD behind your name, not on the name of the person above you. Andrew ----- Original Message -----=20 From: Nick Nudell=20 To: trauma-list@trauma.org=20 Sent: Saturday, April 12, 2003 7:01 PM Subject: Re: pain and suffering 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 -----=20 From: Andrew J Bowman=20 To: trauma-list@trauma.org=20 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 -----=20 From: michael riordan=20 To: trauma-list@trauma.org=20 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?=20 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. =20 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.=20 Michael ------=_NextPart_000_00ED_01C301BF.D52D4140 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable <!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"> <HTML><HEAD> <META http-equiv=3DContent-Type content=3D"text/html; = charset=3Diso-8859-1"> <META content=3D"MSHTML 6.00.2719.2200" name=3DGENERATOR> <STYLE></STYLE> </HEAD> <BODY style=3D"COLOR: #000000; FONT-FAMILY: Tahoma" bgColor=3D#ffffff> <DIV><STRONG><FONT size=3D2>Nick,</FONT></STRONG></DIV> <DIV><STRONG><FONT size=3D2></FONT></STRONG> </DIV> <DIV><STRONG><FONT size=3D2>Thanks for your feedback. The "pain = management"=20 protocol used by the outlying service in question allows for = titrated=20 morphine for the treatment of ISOLATED extremity injury. It is = clearly=20 stated as such IN the protocol. However, we still receive patients = who=20 have received 10mg or more of MS for their multi-system trauma. = Their=20 medical director has been informed but nothing has=20 changed.</FONT></STRONG></DIV> <DIV><STRONG><FONT size=3D2></FONT></STRONG> </DIV> <DIV><STRONG><FONT size=3D2>Yes, altered LOC is one of many s/s of head=20 injury. But if the patient was alert before and now is altered = after MS,=20 is it JUST the MS or an expanding lesion, or brain ischemia, or=20 hypoxia???</FONT></STRONG></DIV> <DIV><STRONG><FONT size=3D2></FONT></STRONG> </DIV> <DIV><STRONG><FONT size=3D2>By the way, you practice paramedicine under = the your=20 medical director, just like I practice nursing and paramedicine (I am a=20 paramedic and a nurse) in my respective environments. To practice = medicine=20 requires an MD behind your name, not on the name of the person above=20 you.</FONT></STRONG></DIV> <DIV><STRONG><FONT size=3D2></FONT></STRONG> </DIV> <DIV><STRONG><FONT size=3D2>Andrew</FONT></STRONG></DIV> <BLOCKQUOTE dir=3Dltr=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=3Dparamednick@comcast.net = href=3D"mailto:paramednick@comcast.net">Nick=20 Nudell</A> </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> Saturday, April 12, 2003 = 7:01=20 PM</DIV> <DIV style=3D"FONT: 10pt arial"><B>Subject:</B> Re: pain and = suffering</DIV> <DIV><BR></DIV> <DIV><FONT size=3D2>Andrew</FONT></DIV> <DIV><FONT size=3D2></FONT> </DIV> <DIV><FONT size=3D2>The purpose of protocols is to remove the = 'borderline=20 vitals' factors so that standardized treatment may be provided. Either = the BP=20 was over 100 or under it (or whatever the particular vital you are = speaking=20 about).</FONT></DIV> <DIV><FONT size=3D2></FONT> </DIV> <DIV><FONT size=3D2>I have not seen 10mg of MS IV do horrible things = to=20 vitals... no, I see pain causing sympathetic rises in vitals which are = then=20 mediated by the removal of the pain. They are not hypotensive because = of the=20 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=20 matter if the altered has come from the MS or a head injury? The fact = the=20 patient is altered is only ONE of many signs/symptoms that would be = used to=20 diagnose a head injury, so really that is a moot point.</FONT></DIV> <DIV><FONT size=3D2></FONT> </DIV> <DIV><FONT size=3D2>I am a paramedic, I DO practice medicine, under = the=20 delegated practice of my medical director. If you have a problem with = the=20 treatment provided by your local paramedics, I would suggest that you = document=20 the problem, provide some evidence for your problem and approach the = medical=20 director who has approved the protocols that you have the problem = with.=20 Period. End of Story.</FONT></DIV> <DIV><FONT size=3D2></FONT> </DIV> <DIV><FONT size=3D2>Nick</FONT></DIV> <DIV><FONT size=3D2></FONT> </DIV> <DIV><BR><FONT = size=3D2>____________________________________________<BR>Nick=20 Nudell, NREMT-P, CCEMT-P<BR>California<BR></FONT><A=20 href=3D"mailto:nudell@prehospital-perspective.com"><FONT=20 size=3D2>nudell@prehospital-perspective.com</FONT></A></DIV> <DIV><FONT size=3D2></FONT> </DIV> <DIV><FONT size=3D2>"Perception is reality" - Wise Old = Paramedic</FONT></DIV> <DIV><FONT size=3D2></FONT> </DIV> <DIV><FONT size=3D2></FONT> </DIV> <DIV> </DIV> <DIV> </DIV> <BLOCKQUOTE dir=3Dltr=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=3Dsumieb@compuserve.com = href=3D"mailto:sumieb@compuserve.com">Andrew J=20 Bowman</A> </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> Saturday, April 12, = 2003 6:38=20 AM</DIV> <DIV style=3D"FONT: 10pt arial"><B>Subject:</B> Re: pain and = suffering</DIV> <DIV><BR></DIV> <DIV><STRONG><FONT face=3DTahoma size=3D2>I have no problem with = medics making=20 decisions, they make sound ones everyday. I have a problem = with medics=20 who break protocol (just like I have a problem with nurses who break = protocol). The problem I describe is a multisystem trauma = patient with=20 borderline vitals who gets 10mg of MS IV.</FONT></STRONG></DIV> <DIV><STRONG><FONT face=3DTahoma = size=3D2></FONT></STRONG> </DIV> <DIV><STRONG><FONT face=3DTahoma size=3D2>Then when they hit the ER, = are they=20 altered because of the MS or brain injury? Are they = hypotensive=20 because of the MS or bleeding?</FONT></STRONG></DIV> <DIV><STRONG><FONT face=3DTahoma = size=3D2></FONT></STRONG> </DIV> <DIV><STRONG><FONT face=3DTahoma size=3D2>Medics do great job, but = they should=20 not be practicing medicine, if they feel a patient would benefit = from an=20 intervention that is not covered by their protocol then that is why = they=20 have radios and cell phones, to call in and discuss/request from the = ED=20 physician getting the patient.</FONT></STRONG></DIV> <DIV><STRONG><FONT face=3DTahoma = size=3D2></FONT></STRONG> </DIV> <DIV><STRONG><FONT face=3DTahoma = size=3D2>Andrew</FONT></STRONG></DIV> <BLOCKQUOTE dir=3Dltr=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=3Driordanms@optusnet.com.au=20 href=3D"mailto:riordanms@optusnet.com.au">michael riordan</A> = </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> Saturday, April 12, = 2003 1:32=20 AM</DIV> <DIV style=3D"FONT: 10pt arial"><B>Subject:</B> pain and = suffering</DIV> <DIV><BR></DIV> <DIV><FONT face=3DArial size=3D2>Andrew,</FONT></DIV> <DIV> </DIV> <DIV><FONT face=3DArial size=3D2> I seem to recall = you posted a like=20 thread like this before. You seem to have a problem with = paramedics making=20 a decision. Do you think every trauma patient in the = field will=20 become hypotensive after morphine is given? Or is it that it only = happens=20 with paramedics? </FONT></DIV> <DIV><FONT face=3DArial size=3D2></FONT> </DIV> <DIV><FONT face=3DArial size=3D2>Luckily in Australia we dont have = such=20 regressive thinking. IC paras dont need to consult. We would more = likely=20 get strange looks at the ED if we took a patient into hospital in = pain=20 (from whatever) that should have been reduced. </FONT></DIV> <DIV> </DIV> <DIV><FONT face=3DArial size=3D2>What is wrong with giving = morphine to a=20 patient in pain? Especially from trauma. Especially in outlying = areas. You=20 would prefer some one to be in pain until the hospital? I cannot = fathom=20 the logic. </FONT></DIV> <DIV> </DIV> <DIV><FONT face=3DArial=20 size=3D2>Michael</FONT></DIV></BLOCKQUOTE></BLOCKQUOTE></BLOCKQUOTE></BOD= Y></HTML> ------=_NextPart_000_00ED_01C301BF.D52D4140--
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