When I became a paramedic, being
able to provide pain management was one of the "new interventions"
that I looked forward to most. As an EMT, I remember countless
times I was without ALS resources and had to watch a patient
suffering in pain until we got to the hospital. Trying to obtain
any history or perform an assessment on someone writhing in pain
can be nearly impossible. As a BLS provider, I would attempt
non-pharmacological ways to relieve pain, such as ice packs, warm
packs, elevating extremities, and sometimes simply trying to
distract them with conversation. While these methods should not be
discounted, I will never forget the first time I could provide pain
medication to an elderly woman who fell and fractured her hip. I
started an IV right there on the floor of the assisted living
facility, administered some fentanyl, and comfortably got her to
the stretcher. Analgesia did not save this lady's life. Still, it
did make her trip to the hospital a little more comfortable and
allowed me to obtain an accurate history, including the dizziness
and dyspnea she felt before falling.
Performing an adequate
assessment and obtaining pertinent medical history can be difficult
when a patient is experiencing intense pain. For this reason, pain
should be managed to a level that allows for comfort &
communication. Total pain relief is ideal but may not always be
feasible, given hemodynamics and underlying
causes.
Check
out this episode with Tyler & Shane as they discuss multimodal pain
management strategies.