Another paramedic tipped me off to a great podcast called Patient Controlled Analgesia by Dr. Edward Gentile.
The bottom line is this physician has come up with an interesting and bias-free pain management protocol.
You apply the same protocol to anyone in acute pain. Young, old, black, white, male, female, rich, poor.
Acute pain protocol for moderate/severe pain
• Administer morphine 0.1 mg/kg IVP (If pt is > 55 y/o, substitute morphine 0.05 mg/kg IVP for this 1st dose) + diphenhydramine 0.5 mg/kg IVP
• 7 minutes later the patient is asked, “Would you like more pain medicine?”
• If the answer is yes, give a 2nd dose of morphine 0.05 mg/kg IVP
• 7 minutes later, the patient is asked again, “Would you like more pain medicine?”
• If the answer is yes, give a 3rd dose of morphine 0.05 mg/kg IVP
• This continues every 7 minutes until the patient answers “no” to the question or the patient is asleep.
This guy is my new hero. His podcast is wildly entertaining and in my opinion, right on.
I have modified his ED protocol to fit the prehospital guidelines we operate under.
If someone is in acute pain, I now simply ask: Would you like pain medicine?
For severe unquestionable pain, I give the first dose 0.1 mg/kg dose spread out over 3-4 minutes. For moderate pain, I may break the first dose down in half, then give the second half fif needed five minutes later. The next 0.05 mg/kg dose, I give ten minutes after the first dose is complete. I dose until I have reached my allowable max which is 0.15 mg/kg up to 15 mg. If they need more, I will call for orders if I am not already at the hospital.
Due to our protocols, I only give the Benadryl if they itch, but I have it on standby as well as zofran if their only complaint is nausea.
I really love this phrase, “Would you like pain medicine?” as well as “Would you like more pain medicine?” I am required to do the pain number scale, but I only ask that after they have answered the pain medicine question. The other day I had a lady who was still a “7’ tell me she was all set as far as the pain medicine after one dose.
I have used the protocol three times now with great success and patient satisfaction.
Dr. Gentile modifies the old slogan “Commit random acts of kindness and senseless acts of grace and beauty,’ to “Commit systematic acts of kindness and sensible acts of grace and beauty.”
I am with him on that all the way.