EMS World

AUG 2018

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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PROFILES IN EMS 38 AUGUST 2018 | EMSWORLD.com Y ou are called for a 37-year-old female, chief complaint "abdomi- nal pain." It is coded low-priority. Sigh. Yes, your preplanning and differentials contain a host of life threats, but experience tells you a sizable percent- age of these calls are nonurgent. The suburban home is well kept, in a quiet neighb orhoo d. A teena ge girl opens the door and says her mother is in the kitchen. Your patient is sitting at the kitchen table. She is petite, quiet, and composed, holding her head in her hand. Your internal monologue sighs again, but you don't let it reach the polite expression of concern on your face. She straightens and smiles apologeti- cally as you walk in. You can see she has good color and is breathing normally. There are no signs of injur y, and she is not doubled over. T h e re i s n o ev i d e n ce of vo m itin g , although there is a wastebasket tucked discreetly next to the chair. There are a few prescription bottles lined up neatly on the table. You introduce yourself and ask her what's bothering her today, and in a calm voice she says, "I am in excru- ciating pain." You nod agreeably, but your skepticism begins to leak through. Your differentials move away from life threats and toward possible behavioral issues—nothing in her presentation screams distress . Despite your growing doubts, you stay the course with your assessment. Your partner attaches her to the moni- tor and cycles the blood pressure: 190/116. Raising an eyebrow, he repeats the pres- sure manually and confirms the reading. You turn back to the patient and ask if she has a known histor y of high blood pressure. She shakes her head and in the same quiet voice says, "I told you, I am in excruciating pain." This time she's the one who sighs. Pain and Gender As providers, as people, we struggle with the concept of pain. It is uniquely personal and not tangible—a nebulous, purely subjec- tive experience no two people will identify quite the same way. As we are discover- ing, no two genders feel it the same way either, and medicine is only now beginning to learn about the collateral damage that has resulted in when it comes to the treat- ment of pain. For EMS providers pain control is not a straightfor ward subject with a clearly defined histor y. In the early days of EMS, you frequently did not treat for p ain unless it was extreme and the doctor on the radio said you could. Our job was to come up with creative stall tactics to help get patients through the ride: "Hang in there, buddy, just a few more minutes." If they had a closed head injur y, it was even worse: The receiving physicians would rail against the crews because their sedatives or analgesics made a preliminar y neuro exam impossible. By Tracey Loscar, BA, NRP, FP-C Anne Montera is the featured keynote speaker at EMS World Expo, Oct. 29–Nov. 2 in Nashville. This 3-part series follows her journey, building to its unexpected conclusion. NOT IN HER HEAD: HOW WOMEN EXPERIENCE PAIN DIFFERENTLY It took nurse Anne Montera years to get her pain accurately diagnosed—but that wasn't the end of the story Montera (second from left) and family Featured speaker at EMS World Expo, Oct. 29-Nov. 2, 2018, Nashville, TN emsworldexpo.com

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