Happy Medic has made a comment on the last post, ‘Anyone for Morphine?’, which I thought I would quickly add to. He mentions that he used to be quite conservative when dishing out his analgesia and explains that :
“I think it came from a Doc in my past telling me I had made the patient so pain free he was unable to assess her knee injury”
He then goes on to say how his practice has changed with his experiences and now manages his patients pain in a totally different way.
There are a fair few paramedics out there that dont seem to ‘like’ giving out Morphine etc.I bet that if you asked most of them what would stop them giving a patient strong opioids when they are in apparent discomfort, a large proportion would come back with the statement:
” the doctor needs to be able to see where the pain is so that he can see what is going on”
This is a really common misconception. In the UK we are governed by the JRCALC (Joint Royal College Ambulance Liason Committee) PreHospital Guidelines. In the 2006 edition, under the section ‘Pain Management’, it clearly states that :
” there is no reason to delay the relief of pain becasue of uncertainty with the definitive diagnosis. It does not affect later diagnostic efficacy”
If you take into account the half life of Morphine, which is approximately 2-3 hours then pretty soon the effects of what we have given the patient pre-hospital will soon enough wear off so that if the doctors really wanted to see how much pain the patient is in then they wont have that long to wait (although I cant ever imagine this happening these days……hopefully!)
Personally, I think this is a humanitarian concept. If I can relieve someones pain, then I will do it, to the best of my abilities. I have never had a complaint from a local A&E stating that I have made someone too comfortable, but I have heard some complaints about paramedics not giving analgesia when it is clearly indicated.
Im sure there is easily two sides to this discussion. There may be some of you reading out there who think that I am wrong in the way I manage pre-hospital pain, but ultimately, in this job, you need to be able to look back on your day and the jobs you have done and know that you have done the very best for your patients that was possible. Including trying to get their pain under control.
Thanks to Happy Medic for starting my mind going!