What kind of analgesic do you use?

[Smash]

To add to systemet's comments, another reason I could see to use an IV NSAID would be if it is being used as an adjunct, to provide combination analgesia. This would make sense for the patient with fractures, but I certainly wouldn't use it on it's own.

As for us, morphine, fentanyl and ketamine (but only on the Whirlybird at this stage).

 

[Flight-LP]

Fentanyl, Dilaudid, Ketamine, Ice / heat, Ibuprofen, APAP, and Toradol.

 

[Handsome Robb]

I'd prefer Nitronox over Fent / Morphine in the vast majority of patients anyhow.

I agree, especially for isolated extremity injuries. It works fine and takes a bit of the workload off the medic seeing as it is an Intermediate skill here rather than making any patient who gets analgesia an ALS patient. The argument I have heard against it is that if it isn't effective in controlling the patient's pain some medics are afraid to load narcs on top of it since the patient's GCS could be below our threshold for narcotics. GCS < 13, but they'd really have to gork themselves out on the Nitronox to get to that point, in my experience at least.

Technically it is still in our protocols but we don't carry the equipment anymore We may still have them available for Special Events Intermediates, I need to check. They printed the books before they decided to pull the equipment off the rig.

 

[mikie]

Why does MIEMSS hate us?

We have a huge arsenal of analgesic options in Maryland:

-Morphine (changed to a weight-based dose this year)

-Tylenol PO for minor to mild pain, recently added (last yearish); how often do i/have i seen it used? once.

-Norm Alsaline for the drug seekers (jk )

 

[Handsome Robb]

I forgot, we have PR Acetaminophen but we only use it for febrile pediatric patients.

 

[MrBrown]

Interesting. Is that common in your country for volunteers and career staff to use different drugs? If so, why?

No, medicines are defined by scope of practice

All Ambulance volunteers now complete the National Diploma in Ambulance Practice which gives them the BLS (EMT) practice level.

I said volunteers because now to reach Paramedic you need a 3 year degree and Intensive Care Paramedic is two years experience as a Paramedic plus a further graduate qualification; there is also rumor of paid BLS Officers being phased out, so there may come a time when there are no paid BLS Officers.

 

[FFEMT427]

In the USA I don't think that anyone uses acetaminophen IV (at least not prehospital). OFIRMEV which is IV acetaminophen was FDA approved recently. I read a study a while ago and I can't for the life of me remember what it was called I beleve it took place in France in which they compared paracetamol to morphine. I can't really see many good reasons to use acetaminophen prehospital for pain. I agree that in some cases PO analgesia would be useful.
As to the use of toradol it is a great med and gives use one more tool in our tool box to bring some comfort to our patients and when used in combo with other treatments makes for very effective pain management.

 

[325Medic]

Fentanyl and Morpine. Benzos are Versed and Valium (awaiting Ativan).

325.

 

[the_negro_puppy]

Morphine
Methoxyflurane (inhaled)
Paracetamol

about to get Fentanyl

 

[HMartinho]

Morphine
Methoxyflurane (inhaled)
Paracetamol

about to get Fentanyl

Your paracetamol can be used by I.V. line?

 

[the_negro_puppy]

Your paracetamol can be used by I.V. line?

Negative, sorry forgot to specify, oral paracetamol

 

[RatMed]

In Poland for paramedics it's morphine and ketoprofen.
Ambulance docs use much wider variety which includes also: fentanyl, pethidine, tramadol, metamizol and paracetamol.

 

[jjesusfreak01]

Technically paracetamol, toradol, and nitronox are within my scope as a (soon to be) intermediate in NC, however we don't carry Nitronox, we generally only give toradol for kidney stones, and paracetamol is used primarily for fever reduction and rarely for pain. To that end, pain management tends to be done only at a paramedic level with narcotics.

 

[Basermedic159]

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

NEVER say your " JUST an EMT-B" You went to school for your EMT just like everyone else did. Have you ever heard a medic say "I'm just a medic",?
The answer is probably no. Look at a medic patch and see whats in front of paramedic ( *EMT*-Paramedic) We're all EMT's, but it's up to you to be an outstanding EMT, or "just an EMT-B"

 

[R99]

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

Somebody needs to read the new clinical guidelines, have you done CCE yet? Fentanyl is here for Paramedic and above but morphine is bring kept also

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.)

Remember that benzodiazapines are.not analgesics but may be used to intensify their effects and lightly sedate the patient

 

[STXmedic]

NEVER say your " JUST an EMT-B" You went to school for your EMT just like everyone else did. Have you ever heard a medic say "I'm just a medic",?
The answer is probably no. Look at a medic patch and see whats in front of paramedic ( *EMT*-Paramedic) We're all EMT's, but it's up to you to be an outstanding EMT, or "just an EMT-B"

I say "I'm just a medic" all the time. It's called understanding your limitations. Just because you went to school like everybody else doesn't mean your educations are even close to equal, and that you don't ever need to punt your patient.

Oh, and there's no EMT in front of Paramedic anymore

 

[triemal04]

NEVER say your " JUST an EMT-B" You went to school for your EMT just like everyone else did. Have you ever heard a medic say "I'm just a medic",?
The answer is probably no. Look at a medic patch and see whats in front of paramedic ( *EMT*-Paramedic) We're all EMT's, but it's up to you to be an outstanding EMT, or "just an EMT-B"

My patch doesn't say EMT anywhere on it. Hasn't for some time now. That's also true for many, many paramedics.

I say "I'm only a paramedic" somewhat often. I hear it from other paramedics as well. In fact, I even hear doctors say (to paraphrase) "I'm just a XXX doctor, I sent them to XXX for a reason.) Insert whatever specialty you like there; heard it from plenty.

I know what I know, and have a pretty good idea how much I don't. (hint; it's a lot). Saying "I'm just a XXX" doesn't mean that you are denigrating yourself or what you do, just that you are aware of the limits of your knowledge and know when it's time to look for help.

I'd rather have someone be honest with me than try and come up with some BS answer because they didn't want to be seen as "just a paramedic."

But...if you want to prance around pretending to be supermedic (or superemt) go for it...

 

[Basermedic159]

My patch doesn't say EMT anywhere on it. Hasn't for some time now. That's also true for many, many paramedics.

I say "I'm only a paramedic" somewhat often. I hear it from other paramedics as well. In fact, I even hear doctors say (to paraphrase) "I'm just a XXX doctor, I sent them to XXX for a reason.) Insert whatever specialty you like there; heard it from plenty.

I know what I know, and have a pretty good idea how much I don't. (hint; it's a lot). Saying "I'm just a XXX" doesn't mean that you are denigrating yourself or what you do, just that you are aware of the limits of your knowledge and know when it's time to look for help.

I'd rather have someone be honest with me than try and come up with some BS answer because they didn't want to be seen as "just a paramedic."


But...if you want to prance around pretending to be supermedic (or superemt) go for it...

^^^
I would like to commend you on taking that comment completely out of context, twisitng it aorund to fit your own agenda at a failed attempt to make sense to yourself and be some type of know it all you claim, not to be. : )

 

[Handsome Robb]

^^^
I would like to commend you on taking that comment completely out of context, twisitng it aorund to fit your own agenda at a failed attempt to make sense to yourself and be some type of know it all you claim, not to be. : )

I didn't see anything taken outta context, but that's just my opinion.

We use fentanyl for analgesia mainly. Morphine in ACS and abdominal pain. In my very limited experience it seems to work better for abdominal pain than fentanyl.

 

[Aidey]

^^^
I would like to commend you on taking that comment completely out of context, twisitng it aorund to fit your own agenda at a failed attempt to make sense to yourself and be some type of know it all you claim, not to be. : )

I would like to commend you on bumping multiple old threads to throw mini hissy fits about how awesome EMTs are and how we Paramedics need to remember where we came from. If you have a bone to pick, start a new thread. But stop bumping old threads for no reason other than to exercise your ego.