On the 10th Day of Christmas Happy Medic gave to me…
10mgs of Morphine
and a British Medic dressed in green
Pain management pre-hospital falls into two categories: Those who know what pain is and those who don’t.
I’ve spoken here before about my burns and how I was almost willing to jump off a cruise ship to get some pain medication, and we have linked extensively to the articles from Rogue Medic, who reminds us that 2mg of Morphine + severe pain = Severe Pain.
If you are considering dosing a person based on a complete assessment, you have to qualify their 10 out of 10 in THEIR terms, not yours. That being said, we also become better care givers when something that we treat happens to us.
As a young paramedic I too dosed low on burns until I was burned. I rarely padded backboards until I ended up on one.
On a recent job a rather large man fell out of bed and injured his hip. On the 5th floor and the elevator is out of service. Groan. After a complete assessment and another look at the staircase, it was decided by the ambulance crew to “Dose and Go.” as one partner went downstairs to get the narcotics from the onboard safe, the other was on the phone to medical control. we are required to get permission to dose more than 20mg and she was already thinking ahead to the staircase.
After dosing an initial 6mg we began to package. Soon after a reassessment another 4mg and the next 10 was already in the medic’s shirt pocket. As we began the downward trek and the truck company was earning their money, our patient was in extreme discomfort. Another 5 and 5 followed quickly and downstairs finally the EMT had another 10 loaded and ready.
The man was in extreme discomfort but not searing pain which he would have experienced had we followed a standard, by the book, treatment plan of 2mg, 2mg, 4mg etc etc. By thinking ahead and knowing your protocols you can make a huge difference in someone’s experience.
This Christmas, I want you to think back to a time in your life when you were in extreme pain and imagine that instead of taking the pain away someone rubbed your back and told you it will be OK. It kind of helps, but what really helps is a chemical reaction in the body that numbs the pain for real.