What kind of analgesic do you use?

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HMartinho

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What kind of analgesic do you use? Here in Portugal, I saw medical professionals using tramadol, morphine sulfate and fentanyl, but recently I saw a nurse using propacetamol IV. As I had never seen this analgesic, I questioned her and she told me that propacetamol was much safer to use in the prehospital environment, than the narcotic analgesics. What do you think?
 
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HMartinho

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But you never seen someone using propacetamol? It is a safe drug?
 
fast65

fast65

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Here we use either morphine or Stadol (butorphanol tartrate)
 
Shishkabob

Shishkabob

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HMartinho said:
But you never seen someone using propacetamol? It is a safe drug?
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Is Acetaminophen / Tylenol a safe drug? As far as drugs go, typically yes. As far as "safer" than a narcotic: No. Drugs are as safe as you make them. Every single medication can kill someone. She's obviously part of the "OMG narcotics cause respiratory depression therefor they are unsafe!" crowd.







In the US, you generally have Morphine and Fentanyl. Some agencies might go a bit further, but those 2 are the most common. Infact, you'll see Morphine/Fentanyl/other narcotic anagelsics than you will NSAIDs, IV or otherwise.
 
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HMartinho

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Linuss said:
Is Acetaminophen / Tylenol a safe drug? As far as drugs go, typically yes. As far as "safer" than a narcotic: No. Drugs are as safe as you make them. Every single medication can kill someone. She's obviously part of the "OMG narcotics cause respiratory depression therefor they are unsafe!" crowd.


In the US, you generally have Morphine and Fentanyl. Some agencies might go a bit further, but those 2 are the most common. Infact, you'll see Morphine/Fentanyl/other narcotic anagelsics than you will NSAIDs, IV or otherwise.
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The point is that I always saw acetaminophen oral or rectal use, never I.V. as given by the nurse.

In my view, I do not believe that propacetamol I.V. is as effective as tramadol, morphine or fentanyl.
 
bigbaldguy

bigbaldguy

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Were there any contraindications to use of opiates in this particular patient? Is it possible he/she might have been a drug seeker and the nurse was trying to avoid giving him a reason to come back? I've seen hospital staff bend over backwards to avoid giving opiates to drug seekers for this reason.

By giving it IV maybe she was trying to give the patient the impression that he was getting the "good stuff".
 
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bigbaldguy

bigbaldguy

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Sorry never answered OP's original question.

We carry Morphine, Fentanyl, and Toradol. I've never seen the Toradol used but I assume we carry it for kidney stones.
 
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HMartinho

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bigbaldguy said:
Were there any contraindications to use of opiates in this particular patient? Is it possible he/she might have been a drug seeker and the nurse was trying to avoid giving him a reason to come back? I've seen hospital staff bend over backwards to avoid giving opiates to drug seekers for this reason.

By giving it IV maybe she was trying to give the patient the impression that he was getting the "good stuff".
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Good point of view.

There is no indications that the patient was addicted. He had suffered a car accident. He had an open fracture of the left tibia, and was slightly hypovolemic, which was the reason we call an imeddiate life support unit, where the nurse start an I.V. line, began the fluid replacement, and given intravenous acetaminophen.
 
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MrBrown

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Volunteers have paracetamol, entonox and some have methoxyflurane

Paramedic's have all of the above plus morphine

Intensive Care Paramedics have all of the above plus morphine+low dose midazolam and ketamine.

Prior to 1990 we had entonox with some Advanced Care Officers (old name for Intensive Care Paramedic) being authorised to use nubain and foratol; then we got very low dose morphine in 1990. In 1999 we got morphine for selected Intermediate Care Officers (old name for a Paramedic) then in 2001 morphine+midazolam was introduced for Intensive Care, 2007 we got ketamine for ICPs. Ketamine is awesome stuff, seen it used with great results many times.

There was some talk around 2009 of replacing morphine with fentanyl but last I heard it wasn't happening.
 
Wes

Wes

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Where I am right now, we have fentanyl and our benzos are midazolam and diazepam. We're supposed to be getting lorazepam next and possibly getting morphine back. (Apparently several of the local cardiologists still prefer it.)

My last service carried fentanyl and demerol for pain management. Benzos were midazolam, diazepam, and lorazepam. Toradol for kidney stones. Ketamine was also an option for certain patients.
 
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Handsome Robb

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We use fentanyl first choice then morphine sulfate. Only time we really use MS is in ACS events.

They just took nitronox out of our protocols, we never really used it anyways.

We have midazolam and diazepam for benzos.
 
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systemet

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HMartinho said:
Good point of view.

There is no indications that the patient was addicted. He had suffered a car accident. He had an open fracture of the left tibia, and was slightly hypovolemic, which was the reason we call an imeddiate life support unit, where the nurse start an I.V. line, began the fluid replacement, and given intravenous acetaminophen.
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I have zero experience with IV tylenol/acetaminophen/paracetamol. I've only ever given it po/pr, mostly to febrile kids.

I would agree that the maximal analgesic effect of tylenol is substantially less than that of morphine or fentanyl.

I can understand opting for fentanyl instead of morphine, if there's a concern that the patient may be hypotensive due to unidentified injuries as a result of significant multisystem trauma.

I could see using acetaminophen if there was some contraindication to other available analgesics. But it seems grossly inappropriate for an open extremity fracture if opiate/opiod based options are available.

* Disclaimer, it's hard to second guess someone else's decision making process when they can't defend themselves.
 
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HMartinho

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systemet said:
I have zero experience with IV tylenol/acetaminophen/paracetamol. I've only ever given it po/pr, mostly to febrile kids.

I would agree that the maximal analgesic effect of tylenol is substantially less than that of morphine or fentanyl.

I can understand opting for fentanyl instead of morphine, if there's a concern that the patient may be hypotensive due to unidentified injuries as a result of significant multisystem trauma.

I could see using acetaminophen if there was some contraindication to other available analgesics. But it seems grossly inappropriate for an open extremity fracture if opiate/opiod based options are available.

* Disclaimer, it's hard to second guess someone else's decision making process when they can't defend themselves.
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Yes, I understand.

I also do not want to counter the nurse "clinical judgment" . She knows more than me, I'm just an EMT-B. Just thought it weird because I never seen anyone using IV paracetamol / proparacetamol
 
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