What do you all think about this issue and please try to go with personal experience and the BS on the news.
There always has to be a crisis to distract us from the real problems our countries facing. Have some doctors over prescribed? You bet, but now anyone who has legitimate pain issues is looked at as a drug seeker.
Perfect example two nights ago my dad had a bad fall and hit his head so hard it bounced off the floor 8-10 inches. We rushed him to the hospital. His head and neck was swollen and he was screaming. My dad isn't one to ask for pain medication, even if he is in pain. He was in the hospital bed crying and anytime they touched his head or neck he screamed. The ER doctor at first wasn't going to five him anything for pain. He told my 75 year old dad he had to deal with it.
I got so heated that I confronted the doctor in the hall. He alluded to the fact the people say their hurt when their not just to get drugs. His damn head and neck and lip was swollen, he wasn't making that up. I dared him to call my father a drug seeker and basically told him that I was going to make two calls, one to our attorney and the next to a family friend that sits on the hospital board. After that he gave him a low dose of Morphine which barely helped and said nothing was wrong. Needless to say my dad was at a Neurosurgeons office today and there is quite a bit wrong and he maybe going in for surgery within the next couple days.
when a head injury or concussion is involved it is common practice to be very cautious giving opiates (or any medication) which depresses the central nervous system .... it is important to be able to keep reassessing neurological status... Even a small amount of opiates can alter neurological symptoms ...especially in the elderly . Not only that in the context of a head injury .. there is already a risk of hypotension increasing intracranial pressure .. Opiates can cause a further drop in blood pressure and respiratory drive .. both of which increase ICP.
Cranial swelling , bleeding and clots can also be delayed and not present initially .
Even without the benefit of a full case history and note of events .., I can understand the doctors reluctance ..
Actually it's not. I was an EMT II for years and for a time in Nevada we could administer certain medications including Atropine, Adrenaline, Morphine, Demerol, Ativan, Thorozine, Zofran, Phenergan and certain cardiac meds. Also, because we were in a very remote area we could administer more powerful medication (we carried Dilaudid on board) if we got the approval of the Medical Director if the transport time was unusually high because Care Flight was either grounded do to weather or was in Service on another call which would happen more then you could imagine.
Yes it can lower resp and blood pressure but that's why you hook them up to a cardiac monitor and also a pulse ox. You start at a low dose and see how the patient tolerates it and raise it from there. The goal is two fold, one to keep the patient alive, but to also keep them comfortable.
The only thing we were taught to never administer is anything that has a blood thinning effect. Back in the day they said never give Opiates or anything sedating because if there was a concussion the last thing you wanted was the person to fall asleep, but that was also debunked in the 80's.
BTW the surgeon my dad saw, who also teaches at the University of California on occasion agreed the doctor was out of line.
of course ..we are only hearing your side of events .. I would love to hear the doctor's .
Treatment of a traumatic brain injury depends on "severity"
and takes into account ... comorbidities .. patient history , presenting symptoms .(including pain) . regular medications .. primary and secondary assessments ... ongoing neurological assessments and diagnostic interventions required .....
stabilising a pt at the scene for transfer to hospital requires additional measures .
I do have more to say about my thoughts on your behaviour .. but it would become personal so I will leave it at that
best of luck . I'm so wrong that the Neurosurgeon said the ER doctor was not only out of line and wouldn't go any further then suggesting we speak with our families lawyer.
He didn't have a damn brain injury, that was determined almost immediately. He's had two neck surgeries, and a back surgery and those were the areas that were swollen, and painful. He's seeing one of the top surgeons in the state. He was a surgeon for the US Olympic Ski Team, but I guess you know more them him as well.
Edited by
Lpdon
on Sun 02/10/19 12:17 AM
