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In our program, we are strongly encouraged to assess, medicate and
document pain issues for our patients. My own personal opinion is
that no one should suffer needlessly during transport. I do not expect to
take a patient's pain away completely, but I strive to mitigate the pain to a
tolerable level for the patient without compromising vital signs,
responsiveness or skewing the examination/evaluation of the patient upon arrival
at the receiving facility. Any patient who is sedated/paralyzed chemically
cannot tell you of the pain they are experiencing. However, the feeling of
pain is there and affects their physiologic status. I saw this first hand
years ago with a head injured, periodically combative patient who had
femur/ankle fractures. After RSI procedure, chemical sedation and
paralysis, the patient's heart rate remained in the 120's, blood pressure
elevated, saturations mid 90's. Wasn't too happy with vital signs, racked
my brain to figure out why things were elevated, then dawned on me how painful
fractures can be. So gave the patient a few doses of morphine.
Magically, heart rate down to 90's, blood pressure down to 140's systolically,
sats up to 100%. Less stress to the patient's system when we recognize and treat
pain response in the trauma patient.
Jo Pufahl, RN, CFRN LifeFlight, Duluth, MN
Question for the group. I recently attended a
conference and spoke to a flight RN from another program regarding sedation
and analgesia for intubated and non intubated patients. I was very surprised
to learn that in her program they are not allowed to give analgesia to their
intubated patients just sedation. The scenario she gave me was a MVC large
amount of trauma -head face chest. RSI intubation and on the flight home with
stable vitals no pain meds. They also don't give pain meds to unintubated
trauma patients. I was wondering where the rest of you stand on this
with your programs. I asked if she would mind if I listed this post and she
was OK with it as long as no names were involved. We routinely give pain
meds to anybody in pain regardless of the disease at hand. I do realize
the trauma team likes a good neuro assessment but pain is pain. Also I
checked with numerous anesthesia practitioners who all stated that they
give narcotics as well as sedation to any intubated
patient.
Thanks for your time
Brent
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