Guest guest Posted August 9, 2006 Report Share Posted August 9, 2006 OK, I am looking for some opinions, and if there are studies that someone could forward, I would love to see them. We carry a couple of drugs for pain management, Fentanyl and Morphine. Nice drugs, they do work and when used properly, they are extremely effective in most people. I am looking for the exceptions to the rule, most notably the addict. I am a strong believer in pain management and see no reason why each patient we deal with should deserve anything less than the next guy, this would include currently addicted patients as well as recovering addicts. Hence the questions I have.. Your patient is a 45 year old male with bilateral femur fractures entrapped (not pinned) conscious and alert, 10 on 10 for pain, hemodynamically stable. The following questions apply. 1) When dealing with a recovering addict (hypothetically 100mg MS PO for 10 years, clean and sober for the last 5 years) how many of you/us would immediately go to the standard dosing regimens for pain relief and stick with it, as opposed to contacting medical control for an increase in the dose? 2) What dosing regimen would you change to, and how effective would it be? 3) How much does a 'tolerance level' of an opiate (or any other abused drug) drop after let's say 5 years of sobriety? 4) If your patient is a current addict, how does your care plan change if at all? 5) If they are a prescription medication addict, any change? 6) Would you consider Versed for it's amnesic effects if in fact the recovering addict refused narcotic pain relief? 7) Personal thoughts are welcome, remember this is in an acute setting. Here is one of mine, living in a single wide trailer on the south side of town, having 3 teeth and 16 tattoos does not preclude you from receiving pain management therapy if you are in pain. The question is, if your patient is just that, and an addict or recovering addict (which they have been nice and honest enough to tell you about) how does your pharmacology care aspect change? This will eventually go into a Power Point, so I am looking for all aspects here. Thanks in advance. Hatfield FF/EMT-P www.canyonlakefire-ems.org " Ubi concordia, ibi victoria " Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 9, 2006 Report Share Posted August 9, 2006 Let me also add a question with regards to non-narcotic analgesics... 1) Would this be a regimen of choice? 2) Do you carry a non narcotic analgesic? Sorry, hit the send button on the first one a little quick Hatfield FF/EMT-P www.canyonlakefire-ems.org " Ubi concordia, ibi victoria " Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 9, 2006 Report Share Posted August 9, 2006 Look into any palliative care website. They have extensive research on pain management. On good resource is www.owourownterms.com -MH >>> hatfield@... 8/9/2006 12:40 pm >>> OK, I am looking for some opinions, and if there are studies that someone could forward, I would love to see them. We carry a couple of drugs for pain management, Fentanyl and Morphine. Nice drugs, they do work and when used properly, they are extremely effective in most people. I am looking for the exceptions to the rule, most notably the addict. I am a strong believer in pain management and see no reason why each patient we deal with should deserve anything less than the next guy, this would include currently addicted patients as well as recovering addicts. Hence the questions I have.. Your patient is a 45 year old male with bilateral femur fractures entrapped (not pinned) conscious and alert, 10 on 10 for pain, hemodynamically stable. The following questions apply. 1) When dealing with a recovering addict (hypothetically 100mg MS PO for 10 years, clean and sober for the last 5 years) how many of you/us would immediately go to the standard dosing regimens for pain relief and stick with it, as opposed to contacting medical control for an increase in the dose? 2) What dosing regimen would you change to, and how effective would it be? 3) How much does a 'tolerance level' of an opiate (or any other abused drug) drop after let's say 5 years of sobriety? 4) If your patient is a current addict, how does your care plan change if at all? 5) If they are a prescription medication addict, any change? 6) Would you consider Versed for it's amnesic effects if in fact the recovering addict refused narcotic pain relief? 7) Personal thoughts are welcome, remember this is in an acute setting. Here is one of mine, living in a single wide trailer on the south side of town, having 3 teeth and 16 tattoos does not preclude you from receiving pain management therapy if you are in pain. The question is, if your patient is just that, and an addict or recovering addict (which they have been nice and honest enough to tell you about) how does your pharmacology care aspect change? This will eventually go into a Power Point, so I am looking for all aspects here. Thanks in advance. Hatfield FF/EMT-P www.canyonlakefire-ems.org " Ubi concordia, ibi victoria " Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 9, 2006 Report Share Posted August 9, 2006 Thanks, I hit a few, but the emphasis is on chronic pain management, most cancer centers have a wealth of info on pain management, and others have a host of info on the use of particular drugs in detoxification, but I am gearing more towards pain management in the addict of recreational drugs. And more importantly, in the acute setting rather than long term care or chronic care. Nothing set me off on it, just a curiosity I guess..not to mention that I am teaching Pharmacology this month for CE, with a 'twist' of pain management, and want to throw something into the fire that will cause discussion and interest, figured this would do it. Hatfield FF/EMT-P www.canyonlakefire-ems.org " Ubi concordia, ibi victoria " Re: Pain management Look into any palliative care website. They have extensive research on pain management. On good resource is www.owourownterms.com -MH >>> hatfield (AT) neopolis (DOT) <mailto:hatfield%40neopolis.net> net 8/9/2006 12:40 pm >>> OK, I am looking for some opinions, and if there are studies that someone could forward, I would love to see them. We carry a couple of drugs for pain management, Fentanyl and Morphine. Nice drugs, they do work and when used properly, they are extremely effective in most people. I am looking for the exceptions to the rule, most notably the addict. I am a strong believer in pain management and see no reason why each patient we deal with should deserve anything less than the next guy, this would include currently addicted patients as well as recovering addicts. Hence the questions I have.. Your patient is a 45 year old male with bilateral femur fractures entrapped (not pinned) conscious and alert, 10 on 10 for pain, hemodynamically stable. The following questions apply. 1) When dealing with a recovering addict (hypothetically 100mg MS PO for 10 years, clean and sober for the last 5 years) how many of you/us would immediately go to the standard dosing regimens for pain relief and stick with it, as opposed to contacting medical control for an increase in the dose? 2) What dosing regimen would you change to, and how effective would it be? 3) How much does a 'tolerance level' of an opiate (or any other abused drug) drop after let's say 5 years of sobriety? 4) If your patient is a current addict, how does your care plan change if at all? 5) If they are a prescription medication addict, any change? 6) Would you consider Versed for it's amnesic effects if in fact the recovering addict refused narcotic pain relief? 7) Personal thoughts are welcome, remember this is in an acute setting. Here is one of mine, living in a single wide trailer on the south side of town, having 3 teeth and 16 tattoos does not preclude you from receiving pain management therapy if you are in pain. The question is, if your patient is just that, and an addict or recovering addict (which they have been nice and honest enough to tell you about) how does your pharmacology care aspect change? This will eventually go into a Power Point, so I am looking for all aspects here. Thanks in advance. Hatfield FF/EMT-P www.canyonlakefire-ems.org " Ubi concordia, ibi victoria " Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 9, 2006 Report Share Posted August 9, 2006 Mike, Another drug you could use is Nubain. It has the effects of M.S. but not the addictive properties. I have learned though to be cautios with recent Narc users trying to quit that it could throw them into withdrawls. In reguards to how my regiment changes for addicts, I just simply look at my patient. If they look like they are in pain, and sometimes their vitals will show it as well (+HR, +BP, +RR) then simply watch how they act and treat you. > > OK, I am looking for some opinions, and if there are studies that someone > could forward, I would love to see them. > > > > We carry a couple of drugs for pain management, Fentanyl and Morphine. > > > > Nice drugs, they do work and when used properly, they are extremely > effective in most people. I am looking for the exceptions to the rule, most > notably the addict. I am a strong believer in pain management and see no > reason why each patient we deal with should deserve anything less than the > next guy, this would include currently addicted patients as well as > recovering addicts. Hence the questions I have.. Your patient is a 45 year > old male with bilateral femur fractures entrapped (not pinned) conscious and > alert, 10 on 10 for pain, hemodynamically stable. The following questions > apply. > > > > 1) When dealing with a recovering addict (hypothetically 100mg MS PO > for 10 years, clean and sober for the last 5 years) how many of you/us would > immediately go to the standard dosing regimens for pain relief and stick > with it, as opposed to contacting medical control for an increase in the > dose? > > 2) What dosing regimen would you change to, and how effective would it > be? > > 3) How much does a 'tolerance level' of an opiate (or any other abused > drug) drop after let's say 5 years of sobriety? > > 4) If your patient is a current addict, how does your care plan change > if at all? > > 5) If they are a prescription medication addict, any change? > > 6) Would you consider Versed for it's amnesic effects if in fact the > recovering addict refused narcotic pain relief? > > 7) Personal thoughts are welcome, remember this is in an acute > setting. > > > > Here is one of mine, living in a single wide trailer on the south side of > town, having 3 teeth and 16 tattoos does not preclude you from receiving > pain management therapy if you are in pain. The question is, if your patient > is just that, and an addict or recovering addict (which they have been nice > and honest enough to tell you about) how does your pharmacology care aspect > change? > > > > This will eventually go into a Power Point, so I am looking for all aspects > here. > > > > Thanks in advance. > > > > Hatfield FF/EMT-P > > www.canyonlakefire-ems.org > > " Ubi concordia, ibi victoria " > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 9, 2006 Report Share Posted August 9, 2006 Hey , Thanks for your post. PLEASE tell us more about your adventures in Kuwait. Share your experiences with us so that we can learn from them. You'll probably see more critical patients in one week than most of us will see in our whole careers. So share, please. Gene G. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 9, 2006 Report Share Posted August 9, 2006 I'm in a different situation working in Kuwait. We care a wide variey of narcotics and those that are not narcotics as well. Morphine, Valium, Versed, Tylenol #3, vicodin as well as toradol, tylenol, ibuprofen, naproxen, Celebrex and if it counts prednisone as well. I rarely have to use narcotics. As a whole toradol, tylenol, ibuprofen, naproxen, celebrex or prednisone does the trick. In all honesty I wish we carried tylenol/ibuprofen and toradol state side. Toradol works wonders I have found and without the narcotic properties. But those are just my thoughts. Vaughn EMT-P > > Look into any palliative care website. They have extensive research on pain management. On good resource is www.owourownterms.com > -MH > > >>> hatfield@... 8/9/2006 12:40 pm >>> > OK, I am looking for some opinions, and if there are studies that someone > could forward, I would love to see them. > > > > We carry a couple of drugs for pain management, Fentanyl and Morphine. > > > > Nice drugs, they do work and when used properly, they are extremely > effective in most people. I am looking for the exceptions to the rule, most > notably the addict. I am a strong believer in pain management and see no > reason why each patient we deal with should deserve anything less than the > next guy, this would include currently addicted patients as well as > recovering addicts. Hence the questions I have.. Your patient is a 45 year > old male with bilateral femur fractures entrapped (not pinned) conscious and > alert, 10 on 10 for pain, hemodynamically stable. The following questions > apply. > > > > 1) When dealing with a recovering addict (hypothetically 100mg MS PO > for 10 years, clean and sober for the last 5 years) how many of you/us would > immediately go to the standard dosing regimens for pain relief and stick > with it, as opposed to contacting medical control for an increase in the > dose? > > 2) What dosing regimen would you change to, and how effective would it > be? > > 3) How much does a 'tolerance level' of an opiate (or any other abused > drug) drop after let's say 5 years of sobriety? > > 4) If your patient is a current addict, how does your care plan change > if at all? > > 5) If they are a prescription medication addict, any change? > > 6) Would you consider Versed for it's amnesic effects if in fact the > recovering addict refused narcotic pain relief? > > 7) Personal thoughts are welcome, remember this is in an acute > setting. > > > > Here is one of mine, living in a single wide trailer on the south side of > town, having 3 teeth and 16 tattoos does not preclude you from receiving > pain management therapy if you are in pain. The question is, if your patient > is just that, and an addict or recovering addict (which they have been nice > and honest enough to tell you about) how does your pharmacology care aspect > change? > > > > This will eventually go into a Power Point, so I am looking for all aspects > here. > > > > Thanks in advance. > > > > Hatfield FF/EMT-P > > www.canyonlakefire-ems.org > > " Ubi concordia, ibi victoria " > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 10, 2006 Report Share Posted August 10, 2006 We carry Toradol at South EMS as well as Morphine, Fentanyl, etc. Jane Hill -------------- Original message from " " : -------------- I'm in a different situation working in Kuwait. We care a wide variey of narcotics and those that are not narcotics as well. Morphine, Valium, Versed, Tylenol #3, vicodin as well as toradol, tylenol, ibuprofen, naproxen, Celebrex and if it counts prednisone as well. I rarely have to use narcotics. As a whole toradol, tylenol, ibuprofen, naproxen, celebrex or prednisone does the trick. In all honesty I wish we carried tylenol/ibuprofen and toradol state side. Toradol works wonders I have found and without the narcotic properties. But those are just my thoughts. Vaughn EMT-P > > Look into any palliative care website. They have extensive research on pain management. On good resource is www.owourownterms.com > -MH > > >>> hatfield@... 8/9/2006 12:40 pm >>> > OK, I am looking for some opinions, and if there are studies that someone > could forward, I would love to see them. > > > > We carry a couple of drugs for pain management, Fentanyl and Morphine. > > > > Nice drugs, they do work and when used properly, they are extremely > effective in most people. I am looking for the exceptions to the rule, most > notably the addict. I am a strong believer in pain management and see no > reason why each patient we deal with should deserve anything less than the > next guy, this would include currently addicted patients as well as > recovering addicts. Hence the questions I have.. Your patient is a 45 year > old male with bilateral femur fractures entrapped (not pinned) conscious and > alert, 10 on 10 for pain, hemodynamically stable. The following questions > apply. > > > > 1) When dealing with a recovering addict (hypothetically 100mg MS PO > for 10 years, clean and sober for the last 5 years) how many of you/us would > immediately go to the standard dosing regimens for pain relief and stick > with it, as opposed to contacting medical control for an increase in the > dose? > > 2) What dosing regimen would you change to, and how effective would it > be? > > 3) How much does a 'tolerance level' of an opiate (or any other abused > drug) drop after let's say 5 years of sobriety? > > 4) If your patient is a current addict, how does your care plan change > if at all? > > 5) If they are a prescription medication addict, any change? > > 6) Would you consider Versed for it's amnesic effects if in fact the > recovering addict refused narcotic pain relief? > > 7) Personal thoughts are welcome, remember this is in an acute > setting. > > > > Here is one of mine, living in a single wide trailer on the south side of > town, having 3 teeth and 16 tattoos does not preclude you from receiving > pain management therapy if you are in pain. The question is, if your patient > is just that, and an addict or recovering addict (which they have been nice > and honest enough to tell you about) how does your pharmacology care aspect > change? > > > > This will eventually go into a Power Point, so I am looking for all aspects > here. > > > > Thanks in advance. > > > > Hatfield FF/EMT-P > > www.canyonlakefire-ems.org > > " Ubi concordia, ibi victoria " > > > > > > Quote Link to comment Share on other sites More sharing options...
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