RE: Trauma analgesia

["Pufahl, Jo" <JPufahl@smdc.org>]

I personally can find no reason to with-hold pain medication from anyone until a physician can examine.  I may titrate or administer pain medications so that the positive effect begins to wear off or is almost worn of prior to landing at the receiving facility.  We do have long scene times as well up in Northern Minnesota/Wisconsin/Michigan and to transport a hurting, writhing individual without compromise to c-spines/other injuries is inhumane.  WE had multiple confrontations with neurology/neurosurgery in delivering patient to the trauma center who were sedated/chemically paralyzed and the docs "couldn't evaluate" because we medicated them.  When we finally got through to them the confines, environment, only 2 sets of hands to handle a patient that takes 8 people in the er, safety issues during flight, etc. they finally backed off.  We again try to titrate/time medications so that the patient begins to "come around" upon or shortly after arrival.

 

Good luck, fly safe and take the best care possible of your patients.  Jo Pufahl, RN, Flight Nurse, SMDC LifeFlight, Duluth

-----Original Message-----
From: JSRN85@aol.com [mailto:JSRN85@aol.com]
Sent: Wednesday, October 09, 2002 12:51 AM
To: flightmed@flightweb.com
Subject: Trauma analgesia

Hello group,

First things first, thank you all for the tremendous response to the sedation/paralytic questions.

Now, on another subject of personal (and professional) interest. I would like to know what programs do with regards to trauma analgesia. In other words, Are there any programs that have in place, protocols for pain management for the trauma patient in the acute setting? Our program carries Fentanyl/Morphine for pain management, and have used both with great success.
I understand that some have the philosophy that acute trauma patients shouldn't be medicated until they are assessed by a trauma surgeon. Our program is unique in that, in our region, a scene call for an MVA, oil field accident, or farming accident can have a one way transport time of 45-60 minutes, and that is a long time to be hurting while being strapped to a backboard. We will, on occassion, use Fentanyl just to make the patient a little more comfortable until we reach the trauma center.  We are currently in the process of revising our protocols regarding this issue.

Any input will certainly be appreciated,

John Smith, RN
AeroCare
Lubbock, Texas