Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Pain Management and Comfort Care

Peter Canning has been counting down the 16 Most Significant EMS Treatment Changes in My 20 Years as a Paramedic and he has #1 as not just pain management, but also comfort care.

In spite of all the time I spend writing about pain management, I do not spend much time on other aspects of comfort care.

When I started in EMS, I did not give morphine at all my first year. I gave it only twice for trauma in the next two years, and then in doses too small to provide relief. This is working in a busy system doing 400-500 ALS calls a year. And for vomiting patient, I never once gave an antiemetic.

“I have to hurt looking at you for you to get morphine from me,” an old school medic taught me when I started.

It’s a new day.

Last year I gave Fentanyl over 50 times, more than any other drug except Zofran, which I gave close to 100 times.

As despicable as the old school medic’s comment that he will only treat your pain to make himself feel better, am I any better when I do not give ondansetron (Zofran) for nausea.

Is ondansetron the only anti-nausea medication that we should use?

All I carry is ondansetron, but there are several other medications for nausea – promethazine (Phenergan), prochlorperazine (Compazine), metoclopramide (Reglan), and droperidol (Inapsine). Ondansetron may not be very effective when used for nausea due to vertigo (vestibular causes), but it seems to be effective for other causes of nausea/vomiting and it appears to have fewer side effects than the other anti-emetics.
 


 

A look at the need for further treatment in the emergency department after treatment by rural EMS with ondansetron.[2] As we learn more, we can adjust what we use.

Go read the rest of what Peter wrote.

Footnotes:

[1] #1 Pain Management and Comfort Care
Street Watch: Notes of a Paramedic
Peter Canning
July 17, 2012
Article

[2] Ondansetron as an effective antiemetic in the rural, out-of-hospital setting.
Benner JP, Ferguson JD, Judkins AE, O’Connor RE, Brady WJ.
Am J Emerg Med. 2011 Sep;29(7):818-21. No abstract available.
PMID: 21641151 [PubMed – indexed for MEDLINE]

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