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 our standards and remove barriers to pain relief.12 EMS providers are often the tail of the dog in pain management; some progressive EMS providers who provide good pain management have found themselves the focus of criticism by certain emergency physicians and nurses. Others simply are stuck in the mire of tradition, bound by archaic rules and unable to progress. Bright spots exist. Practices are changing. Many progressive emergency physicians and EMS medical directors are leading the fght for better pain management, and there are many EMS providers who provide excellent pain relief. patients with acute abdominal pain. Ulus Travma Acil Cerrahi Derg, 2012 Sep; 18(5): 397–404. 12. Motov SM, Khan AN. Problems and barriers of pain management in the emergency department: Are we ever going to get better? J Pain Res, 2008 Dec 9; 2: 5–11. William E. "Gene" Gandy, JD, LP, NREMT-P, has been a paramedic for more than 30 years. He has testified in court as an expert witness in a number of EMS cases. He lives in Tucson, AZ. Steven "Kelly" Grayson, NREMT-P, CCEMT-P, is a critical care paramedic for Acadian Ambulance in Louisiana. Conclusion In this era of iPods and digital media, EMS pain management seems stuck in the days of boom boxes and cassette tapes. It's time we tossed the old attitudes about pain management, like those old boom boxes, into the dustbin of history. (And kids, if you don't know what a boom box or cassette tape is, ask your parents.) REFERENCES 1. Silen W, Cope Z. Cope's Early Diagnosis of The Acute Abdomen, 21st ed., Oxford, NY: Oxford University Press, 2005. 2. Brewster GS, Herbert ME, Hoffman JR. Medical myths: Analgesia should not be given to patients with an acute abdomen because it obscures the diagnosis. West J Med, 2000 March; 172(3): 209–210. 3. Zoltie N, Cust MP. Analgesia in the acute abdomen. Ann R Coll Surg, 1986; 68: 209–210. 4. Attard AR, Corlett MJ, Kidner NJ, Leslie AP, Fraser IA. Safety of early pain relief for acute abdominal pain. BMJ, 1992; 305: 554–6. 5.Thomas SH, Silen W, Cheema F, et al. Effects of morphine analgesia on diagnostic accuracy in emergency department patients with abdominal pain: a prospective, randomized trial. J Am Coll Surg, 2003 Jan; 196(1): 18–31. 6. Thomas SH, Silen W. Effect on diagnostic efficiency of analgesia for undifferentiated abdominal pain. Br J Surg, 2003; 90(1): 5–9. 7. Ranji SR, Goldman LE, Simel DL, Shojania KG. Do opiates affect the clinical evaluation of patients with acute abdominal pain? JAMA, 2006 Oct 11; 296(14): 1,764–74. 8. Manterola C, Astudillo P, Losada H, Pineda V, Sanhueza A, Vial M. Analgesia in patients with acute abdominal pain. Cochrane Database Syst Rev, 2007; (3):CD005660. 9. Bailey B, Bergeron S, Gravel J, Bussieres JF, Bensoussan A. Efficacy and impact of intravenous morphine before surgical consultation in children with right lower quadrant pain suggestive of appendicitis: a randomized controlled trial. Ann Emerg Med, 2007 Oct; 50(4): 371–8. 10. Goldman RD, Narula N, Klein-Kremer A, Finkelstein Y, Rogovik AL. Predictors for opioid analgesia administration in children with abdominal pain presenting to the emergency department. Clin J Pain, 2008 Jan; 24(1): 11–5. 11. Gungor F, Kartal M, Bektas F, Soyuncu S, Yigit O, Mesci A. Randomized controlled trial of morphine in elderly For More Information Circle 36 on Reader Service Card EMSWORLD.com | MARCH 2013 29

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