[ccm-l] Emergency - Free AIR

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Doug,

It was a statement of record on the original post that it was the surgiical 
resident who wanted to deny this patient analgesia.  Unfortunately it is 
usually a surgeon (often junior) who wants to deny patients pain relief - 
you can consider this stereotyping if you like but it happens to be so.

As for the validity or otherwise of consent given under the "influence" of 
medication, surely it is time  to change attitudes on this too.  I would 
consider consent given when the patient was calm and comfortable to be far 
more valid than consent given when he was distraught with pain.  Remember, 
with titrated  IV narcotic we give enough to make the patient comfortable - 
not blot them out non compis mentis.

John

Dr J Holmes
Director Emergency Medicine
Mater Adult Hospital
Brisbane, Australia


>From: Douglas Geehan <geehand at umkc.edu>
>Reply-To: Trauma & Critical Care mailing list 
<trauma-list at trauma.org>
>To: Trauma & Critical Care mailing list 
<trauma-list at trauma.org>
>Subject: Re: [ccm-l] Emergency - Free AIR
>Date: Wed, 26 Jan 2005 11:21:16 -0600
>
>John,
>
>I feel compelled to comment here.  Posturing behind stereotypes
>always leads to a devolution of the discussion.  How do you
>implicate "surgically driven" in this scenario.  The resident 
is
>actually looking out for the best interests of the patient...to get
>to the OR as quickly as possible.  I have personally had well
&g;intentioned, but misguided, individuals try to invalidate an
>operative permit because the patient had received narcotics and/or
>sedatives.  Their "thought" process was that the patient was 
under
>the influence of medication, and therefore, could not give informed
>consent.  This scenario has played out multiple times.
>
>On a side discussion, the administration of narcotics judiciously
>can actually facilitate the examination.  What can drive surgeons
>crazy, however, is the administration of "stealth" narcotics.  
When
>the decision process is based on serial exams, an improvement from
>narcotics can be attributed to an improvement in physiology.
>
>Doug
>
>>He is screaming for pain medicine.  Surgical resident  thinks he
>>might need an operation, and wants to withhold narcotics until op
>>permit signed.
>>
>>
>>Is there no end to this surgically driven sadism?
>>
>>John
>>
>>Director Emergency Medicine
>>Mater Adult Hospital
>>Brisbane, Australia
>
>
>--
>Douglas Geehan, M.D.
>Associate Professor
>Department of Surgery
>University of Missouri-Kansas City
>geehand at umkc.edu
>
>
>--
>trauma-list : TRAUMA.ORG
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