I used to get upset when the call was for an old fall or fall yesterday or fall last night. The same when Iâ€™d get called for abdominal pain and a person says they have been having the pain for two weeks or three months. I got upset because the nature of the call was not acute. When many think of EMS, they think of us responding to sudden emergencies. We think this way most of the time, as well. Not an acute emergency, why are you bothering us? So the pain is not new, why didnâ€™t you call when it happened? Two weeks, really, never thought to go to the ED before now? But think about this: assuming their levels of pain are the same, who do you think more of? The man with pain who sucks it up for a week until he canâ€™t take it anymore or the man who calls 911 after only 15 minutes of pain.
The question I always try to get answered is why did you call now?
The answer is usually one of two.
A. The pain kept getting worse until the point where I just could not take it anymore
B. I ran out of pain medicine, and now is a convenient time for me to get to the hospital and get some more pills
I am all for treating pain, but when it comes to nonacute pain, it gets less easy.
Here is how I handled each of these two scenarios in recent weeks.
A. Patient has had abdominal pain for three days. He is at home watching the football game. He is wearing a New York Giant hat and wearing a New York Giant t-shirt. There is a plastic waste basket by the couch side that the patient has been vomiting into. On TV the Giants are locked in a tight game with their opponent. The man lives three blocks from the ED.
B. The woman was in a car accident a week ago. They gave her Ultram at the hospital and Ultram does nothing for her. She hurts all over. She usually takes Percocet for her back pain, but she has been out for several days. She says canâ€™t take the pain anymore. She lives three blocks from the hospital. When we arrive, she has her coat on and is locking her front door.
Both said they were 10 of 10 on the pain scale.
I gave patient A 100 mcgs of Fentanyl and 4 mg of Zofran. I treated Patient Bâ€™s pain by getting her as comfortable on the stretcher as possible, fluffing her pillow, talking courteously to her and using â€œdistraction therapy for pain management.â€
Patient A I believed was in true agony, and was only calling because he truly couldnâ€™t take it. Patient B seemed more like getting her Percocet renewed was just another item on her list of things to do for the day.
I always wonder if I did right.
Patient A ended up in a hospital bed in a room with a TV set where he fortunately got to see his Giants come back to win the game.
Patient B ended up in the waiting room.
Sometimes I wish pain management were simpler. I wish there wasnâ€™t so much controlled substances paperwork and the need to exchange kits after every use, and so many cautions about possible drug seekers or excess concern about side effects, and just plain judgment. I wish that other caregivers wouldnâ€™t say, â€œYou gave them how much!â€ And I wouldnâ€™t have to always explain the patient is stable and still in pain, and likely needs more. I wish that for every patient who said they were in pain, we could just turn on pain medicine like oxygen and let it flow.
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