Pain control for Abdominal pain patients

[Paramedic503]

Hang on sports fans, I'm gonna start a war! :lol:

Talked with a Medical Director of another service the other night, and we some how ended up on the topic of pain control. Like many places, any abdominal pain other than kidney stone type pain (with hx) means no pain control in the field.

He said that there's a whole load of new studies out there providing a new insight. Basically, if the patient is in severe abd pain, anywhere you palpate on their abd is gonna hurt. Giving them a little pain control, would take the edge off the pain and also allow you to narrow down the specific area of the pain.

Has anybody ran across any of these studies? I'm gonna start looking into it for my service and would love to share information.

[M&M]

Our problem is that each dr. we have in the er is totally different. One of them goes nuts if we give anything when a pt. has abdo pain. The other will just let us do what we think is right. Personally, I think that if it's bad enough, you've gotta do something to tone it down so you can evaluate what's going on. Something like starting small with 2mg ms then titrating up as needed. If you know of any quick acting meds out there other than MS that are easy to control, let me know. Abdo pain gives us all a headache :bang:

[Paramedic503]

Yeah I know, that's what I'm afraid of..All the ER Docs.. Well I'm pulling a 48 this weekend so I think I'll poke around and see what the majority opinion is.
;)

I did find about 4 or 5 good studies online today that support it.

I'll keep ya all informed!

[Nate]

Yeah I know, that's what I'm afraid of..All the ER Docs.. Well I'm pulling a 48 this weekend so I think I'll poke around and see what the majority opinion is.


Me too, nice to know I'm not the only one losing their weekend. ;)

I agree with the 2mg of morphine, I was thinking that too...that is enough to take the edge off, but not enough to make them forget it.

[hageremtp]

Nitrous Oxide

[firechic]

I have heard of studies regarding that topic. I have also read a bunch of studies where pain is not being treated in the field and major lawsuits are being won because the pain was not controlled and suffering ensued.
I think it does more harm than good to wait to give some relief.

[WELLAGEDEMT]

I have to ask a couple of questions, Do your protocols allow you to mess with the patients' symtoms and eliminate a source of detection for the real Drs.?????? How can you be sure that either way, with treatment or without, that the patient will show the same symtoms to the ER docs and still not sue your behind for wrongful treatment or not enough treatment? It seems to me to be a gray area when you start doing the Drs. diagnosing for him. If I had a choice, I would probably agree with Hager!!!!!!!

[Mushroomedic]

We are allowed to treat "pain" with up to 20mg of morphine and ablility to call if we choice to exceed this. Under our Abd pain protocol we are to call first but in my situation (rural provider) this may not always happen. I have yet to ever have a doc get upset with tritrating to effect of giving comfort. We also carry Nitrous Oxide but I generally don't use it with abd pain but for a start with kidney stones.
Wellaged the goal is not to totally eliminate the problem but to merely put them at ease so as to properly evaluate them and transport. As for the other questions the same arguement can be made for a CHF with PE if given O2 (now CPAP), NTG, Lasix, and MS I may correct the problem in my hour transport so as to present a patient with no s/s upon arrival.

[emsgirl]

I have only given morphine to one patient with abd pain (still in internship here). I think having the patient screaming and the whole devine intervention thing going in the background helped with OLMC. Course ten of morphine and 4 of zofran did not even touch her either her pain or her retching.

[RyanEMVFD]

High Flow Oxygen for us. Only thing allowed by Med Control.

[IAMedic]

Our Medical Director just approved morphine up to 10 mg (prehospital) for Abdominal pain unless there is a chance they could be pregnant. The State approved morphine for Abd pain this year, I believe. Up to this year, we were not suppose to give any morphine to Abd. pain patients. I'm happy with the new protocols.

The deal with morphine masking pain is irrelevant in my view. If the patient is c/o abdominal pain they need help with that pain. In my opinion you aren't masking the pain because it was there and once the short-lasted morphine wears off, it will be there again. If we have a patient that is brought into the ER with Abd. pain, they get a normal Abd. pain workup. We don't say "Oh, your not in pain anymore, problem solved". They get a complete workup.

When you are in pain, your heart races causing you to pump more blood. If you have an AAA, this is very bad. If we can ease their pain and calm them down a bit, we may be able to help their situation out. Any comments??

Oh and Mike, it's good to see you again. How are things down that way??

Ray, I met your Ambulance Director the other day...Good Luck!!

[firechic]

I have to ask a couple of questions, Do your protocols allow you to mess with the patients' symtoms and eliminate a source of detection for the real Drs.?????? How can you be sure that either way, with treatment or without, that the patient will show the same symtoms to the ER docs and still not sue your behind for wrongful treatment or not enough treatment? It seems to me to be a gray area when you start doing the Drs. diagnosing for him. If I had a choice, I would probably agree with Hager!!!!!!!

WellagedEMT - hold on a second!! I never said I ever started doing the Dr's diagnosing for him/her. I only said I took the edge off of the abdominal pain. Yes, my protocols allow me to take some of the patient's pain away prior to and during transport before reaching the ER. I think more and more agencies are changing the hands off approach to patients in the field with abdominal pain. There are many patients I bring into the ER with S/S that have resolved in transit. As long as I write a clear, concise report, treat my patients accordingly and to the high standards of my protocols and act in every manner in the best interest of my patient - I don't see how my "behind" would be in distress.
My department stopped carrying NO a long time ago, so that's not an option for me.
Have a good night ya'll - I'm going to bed!! ;)

[WELLAGEDEMT]

My question still remains, If you are taking away pain are you masking some of the vital symptoms for the ER Docs???????? Wellaged is only in my age not my experience. I may be older than dirt but my EMT experience is very recent llike 4 or 5 yrs.:lol:

Don't take any offense from what I asked, I wasn't questioning anything you did, I was only asking about masking the pain, Yes I did make a reference about diagnosing but that also was in regard to the masking of symptoms. I just ask questions.

[smurfe]

My question still remains, If you are taking away pain are you masking some of the vital symptoms for the ER Docs???????? Wellaged is only in my age not my experience. I may be older than dirt but my EMT experience is very recent llike 4 or 5 yrs.:lol:

Don't take any offense from what I asked, I wasn't questioning anything you did, I was only asking about masking the pain, Yes I did make a reference about diagnosing but that also was in regard to the masking of symptoms. I just ask questions.

As most have stated, in these situations, the goal isn't to make them pain free, but to be able to tolerate the pain.

Actually also, a lot of the thought behind not giving the narcotics in these situations in the past wasn't actually masking the pain, but having patients sign consent forms for surgery while under the influence of a narcotic.

Smurfe :beer:

[firechic]

Don't take any offense from what I asked, I wasn't questioning anything you did, I was only asking about masking the pain, Yes I did make a reference about diagnosing but that also was in regard to the masking of symptoms. I just ask questions.

Oh, I didn't take any offense to what you said, nor did I mean to sound as though I did. We're just contributing to the conversation. There's nothing wrong with asking questions.....I do it all the time!!

[Tacmedic]

I work for a county hospital based ambulance and we do utilize medication prehospital only to help decrease pain levels, not to take away. This also depends on the distance from the facility we must travel. Patient care comes first even if that means making the doctor's job harder, and if all else fails that's what medical control is for. Plus thats why doctors have labs, CTscans and other tests, and honeslty I'd say 4 out of 10 go to surgery when everthing shows negative just to make sure.

[Paramedic503]

Sorry for my lateness on replying, but it's been one of those weeks. :bang:

Like I said when I started this thread, I didn't intend for it to start a war.

My plan for this protocol is as many of you have stated...Not to eliminate the pain totally but to "take the edge off". I've talked to a couple of ER docs around my area and surprisingly got a very positive response. Seems as if many of our ER docs are doing the same thing now a days. Not totally eliminating the pain, but reducing it to a tolerable level for the patient.

Thanks for the good discussion!!

P.S. Brad, nice to see ya too!! :p

[Nate]

I still think low dose morphine would work, plus if you give to much...it is something you can reverse if you give to much.

[Garyb3985]

Just last month I had a Pt. that I was transporting from a larger hospital to a smaller one for rehab.While enroute the Pt. complained every 5 seconds of abdominal pain. I got tired of hearing it so I ask her if she would like some MS for the pain. I told her I would call and get a order for some .Before the call i noticed the saline lock came loose from her arm. just as I finished tapeing it down the Pt. had so much relief from the pain.And all I did was tape the lock down!!!!!

I said all that to say this.

If we were to start just giving out MS for abd. pain it wouldn't be long and every drug seeker we know would have abd. pain!!Just like they know if they have"chest pain" they are going to get some.

[champ]

I have heard of studies and the use of Nitros in the Charlotte, N.C. to aliviate most types of pain. I think the justification of this followed the line that the drug is ingested and offloaded through the respiratory system and therefore did not have to be digested and offloaded through the GI tract possibly causing more damage or harm with an unknow Abd. problem. The only draw back I can see here is the effects of Nitros on the body where as it is almost like versed wher the pt. forgets they have pain making you diagnosis harder because the pt. is less likely to be able to help you narrow the cause. On the other hand, you do end up with a pt. who is not suffering in pain while you take them to the hospital and the effects of Nitros are relatively fast acting and short lived once the administration has stopped.

[babyemt]

as for the protocal where i live. it is frowned upon to give pain meds for abdominal pain unless it is caused by crohns or history of stones with approtiate signs and symptons, or if the pain is very severe on the judgement of the medic.