EMS World

MAR 2013

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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BEHIND THE MYTHS tests often done before an adequate history and physical examination, the suffering patient is sometimes forced to wait for many hours before any relief is offered. This cruel practice is to be condemned, but I suspect it will take many generations to eliminate it because the rule has become so firmly ingrained in the minds of physicians. A recent prospective randomized trial has shown that the early administration of morphine to patients with acute abdominal pain does not obscure the correct diagnosis or delay appropriate treatment.1 Some argue that a patient given opioids will lack the mental capacity for informed consent for treatment. This argument does not hold water unless the patient is medicated to the point of sedation. If the patient has the cognitive ability to understand her circumstances, understand an explanation of what is proposed to be done r from ette B and rationally evaluate those two items and come to a rational judgment about treatment, then there is no problem. Unlike in decades past, opioids may now be given intravenously and titrated to pain relief, and if the patient is given so much medication that rational consideration is not possible, reversal is an easy option. It can just as easily be argued that a patient suffering excruciating pain may be as unlikely to make a rational decision as a medicated patient. Indeed, the hurting patient may feel coerced into consenting to a procedure.2 The Studies Numerous studies have examined the effects of opioids on the ability of physicians to diagnose abdominal pain. As long ago as 1986, Nigel Zoltie and Michael Cust studied 100 patients in the U.K. who were given opioids for angle any At PL Custom, we're unique in many ways – from delivering lasting value to understanding your needs and exceeding your expectations. Find out more about our unmatched commitment to customer satisfaction. 800-PL CUSTOM PLCUSTOM.COM For More Information Circle 15 on Reader Service Card 26 MARCH 2013 | EMSWORLD.com abdominal pain and concluded there was no evidence of masking of physical fndings.3 Six years later a similar study resulted in similar fndings.4 In 2003 a study published in the Journal of the American College of Surgeons compared 36 adult patients who were given placebos with 38 adult patients who were given morphine. The study found no evidence of masking of symptoms or differences in physical exam results and diagnosis between the two groups. It concluded that early administration of analgesics to patients with undifferentiated abdominal pain should not be contraindicated.5 Silen and Stephen H. Thomas evaluated these three studies along with several others in 2003 and concluded that "judicious provision of analgesia appears safe, reasonable and in the best interests of patients in pain."6 However, there were some weaknesses in the

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