On Pain

In my years as a paramedic I have learned many things through hard lessons. Some have been at the expense of my pride. Believe me when I tell you that you need to start at your basics. I firmly believe that, not because its something written in stone in some textbooks, but because starting with the basics slows you down. It makes you concentrate on the steps you need to complete, even if your completing them very quickly, to minimize the chance you miss something on your patient.

The basics.

Sometimes this means taking treatment one step at a time. I have talked about how something like CPAP has greatly diminished the amount of necessary RSI’s due to CHF. We start with a simple examination followed by CPAP and then advanced interventions. Sometimes with just those treatments the patients begin to show marked improvement. The improvement that we see is very quantifiable. Respirations decrease in rate, lung sounds improve, oxygen saturation goes up, LOC improves. These are things we can see, we can mark and show as proof of what we were doing had a great benefit.

Pain is different.

Yes we have a scale for pain, but it is largely based on what someone is telling us. We have to base it on vital signs, on appearance, on what they are displaying. The problem is it mainly is a judment call. I have heard of medics that administer medication for pain on everyone and in the same system there are paramedics that have never administered any pain meds in many months. My guess would be both are wrong some of the time. It can’t be that everyone needs pain management one medic meets while in the same system, with the same protocols, another medic doesn’t see any patients that need pain management. Protocols have a lot to do with it. For example in my system most paramedics have to rely on medical control to give them the go ahead for pain management with narcotics. Some of us that are flight certified do not need to call for medical direction. Within what we can do there is a great grey area. I am sure this can lead to different medics deciding different treatments for the same type of patient.

An article on how to manage pain by EMSWorld caught my attention and I recomend reading it to anyone in EMS. The fact is that many of us, including many with years of experience, can misdiagnose a patient’s pain. It is very enlightening that many of the things we used to associate with reasons not to give pain management has been proven to be incorrect. Obviously you should always follow your protocol, but it should always be important to treat the patient to the best of our ability.

Here’s a link to article: EMS world

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