Tramadol speak..!

[Guest guest]

What is AC separation....why does it need an X-ray and how is it related to

shingles pustules..?

 

Thanx

 

P

From: Wilf Mackie <w.mackie@...>

Subject: Tramadol

Date: Monday, 13 October, 2008, 5:24 AM

Greetings all:

Tramadol ? This one I have not used any advice or experience with this Rx it was

prescribed for patient I treated for AC separation OR shingles (pick one)

Seriously the fastest MD diagnosis I have ever witnessed ....4 minutes from

admission to discharge " total time " with no x-ray to rule out AC partial

separation and with a PMHX of AC separation 3 days before .... appears that 2

pustules are the definitive Dx with Shingles ... this was a weird call. Needless

to say I have sought a real MDs input.

Flip .....

Thanks to Larry/Rob I was going to remove Toradol from my inventory, but will

keep it for renal colic now.

cheers

Wilf

[Guest guest]

> What is AC separation....

Achromio-clavicular = shoulder

> why does it need an X-ray

To determine extent of injury, although that is often immediately followed with

an MRI

> and how is it related to shingles pustules..?

It isn't, and that was Wilf's point.

Rob

[Guest guest]

et all:

Firstly thanks for all the info ... sans the Lemon Cocco Butter applications

eeuwww, my eyes watered.

I suspect I should explain the presenting patient.

PMHX: 48 y/o, Male, not on routine rx, no allergies.

C/C: Onset of pain to mod to severe pain to left shoulder while taking off his

shirt 4 days ago, with chronic acromioclavicular dislocations noted from his

history. Patient states " it went out, then in " and for 2 days tolerated the

discomfort, quite typically treated with Tylenol, Ibuprofen and ETOH (this is

the oilpatch after all)

Day 3 increasing pain, pt. contacted myself, I assessed this fellow, without

shadow of doubt in a lot of discomfort, 9/10 for pain.

ps (I too have had some knitting done in my left AC joint, its major pain and

requiring LOTS of " Percocet/Oxycodone " why hurt when the great spirit made the

Opium poppy but then again I have a good GP and he drinks good scotch too, I

digress.

PE: Full range of motion, good distal pulses, extremity not cool to touch, good

cap refill but obvious decreased strength, complained of some mild parenthesis

to lateral aspect of triceps.

I send him into hospital with a driver 2 hours on very bumpy gravel road,

believing that he would return with better Rx than I have for moderate pain

relief. I only have Toradol for injection only (Rob makes a good point sedation

side effects by a Paramedic resulting in an injury = huge liability issues)

So a resident MD " R2 on call " concurs with partial dislocation gives patient x 6

Tylenol #3 (acetaminophen 500 mgs and 30mgs Codeine) pretty much a waste of

effort and no x-ray available, come back tomorrow .... bump, bump back to site,

with an even more upset patient.

Day 4: Patient calls ... I find patient in severe Pain .. enough is enough ....

smoke the sucker with 13 mgs MS over 3 hour period, small increments IV Push to

effect. I take him back, a supposedly real MD does the 1 minute assessment on

shoulder, locates 2 or three tiny pustules (not vesicular in nature) on lateral

aspect of upper arm .... diagnosis in 4 minutes flat a new world record, should

we tell him that they appeared 4 days after the initial complaint and the

patient was using a Tiger Balm type rub possibly irritating the skin ? Nope to

late for that punt .... out the door.

Point is I have seen quite a few cases of shingles and had a bout with them

myself but typically a rash is observed midline spinal column posterior with

radiation around to anterior (dependant on Dermatome level affected) and

unilateral in majority of cases. Also the MD stated dermatome " C2 level

affected " , and this I know is crap, upper arm is C 4 or 5 !

So he writes a script for Acyclovir and Tramodol ... hence the my query.

I have never heard of this stuff so was wondering if anyone had any first hand

experience with it, I can read the literature but it states the T#3 are

effective too... pfft, the only thing they do for me is get me constipated and I

can pop them like pez candies without any effect.

My conclusion: I send patient to a real hospital, the big city about 4 hours

drive (family driving after the Morphine) so maybe some x-rays ? to rule out AC

partial separation ? Things like a temperature, ps I did not because I believed

I was looking at musculoskeletal situation, maybe a CBC ... yea know like that

medical stuff.

cheers

Wilf

Tramadol speak..!

What is AC separation....why does it need an X-ray and how is it related to

shingles pustules..?

Thanx

P

.

[Guest guest]

Hi gang,

for those intereseded,

the use of Torodol is " routine now in our area for the treatment of suspected

kidney stone. We are also adding Flomax and alpha blocker used for many with

prostate hypertrophy to aid in urine flow.Given the age of folks on the rigs and

the potential for stonmes it may be considered .

Wilf, I would  keep the Torodol if you can, as a wider armateriam is always

better.

Regarding the " Euphoria " comments. I have not encountered that with TRAMADOL(

ULTRAM) with patients I prescribe for nor when I have used it myself Post

op...would have been nice:). Instead it was a a nice way for me to have a

NON-NARCOTIC med to keep working after shoulder surgery.

AC seperation is ACROMIO CLAVICULAR SEPARTATION.. essentially a ligament tear or

stretch ( feel the bump at top of your shoulder)-painful and can be acompanied

by a clavicle fracture or tear in other cartalidge of the shoulder- quite

painful.

Bye for now.

Gerry

From: Wilf Mackie <w.mackietelus (DOT) net>

Subject: [Remotemedics. co.uk] Tramadol

@groups. com

Date: Monday, 13 October, 2008, 5:24 AM

Greetings all:

Tramadol ? This one I have not used any advice or experience with this Rx it was

prescribed for patient I treated for AC separation OR shingles (pick one)

Seriously the fastest MD diagnosis I have ever witnessed ....4 minutes from

admission to discharge " total time " with no x-ray to rule out AC partial

separation and with a PMHX of AC separation 3 days before .... appears that 2

pustules are the definitive Dx with Shingles ... this was a weird call. Needless

to say I have sought a real MDs input.

Flip .....

Thanks to Larry/Rob I was going to remove Toradol from my inventory, but will

keep it for renal colic now.

cheers

Wilf

[Guest guest]

Wilf,

Maybe other here can give a better idea, but every time I have used tramadol I

have not been terribly impressed with it. From my purely subjective view, it

seems to be about the equivalent of giving the patient some acetaminophen with

codeine (Tylenol 3), only in injectible form.

The Oxford League Table of Analgesics

http://www.medicine.ox.ac.uk/bandolier/booth/painpag/Acutrev/Analgesics/Leagtab.\

html seems to bear this out.

Jim

----- Start Original Message -----

Sent: Sun, 12 Oct 2008 22:07:58 -0600

From: " Wilf Mackie " <w.mackie@...>

< >

Subject: Re: Tramadol speak..!

>

> et all:

Firstly thanks for all the info ... sans the Lemon Cocco Butter

applications eeuwww, my eyes watered.

I suspect I should explain the presenting patient.

PMHX: 48 y/o, Male, not on routine rx, no allergies.

C/C: Onset of pain to mod to severe pain to left shoulder while taking

off his shirt 4 days ago, with chronic acromioclavicular dislocations

noted from his history. Patient states " it went out, then in " and for 2

days tolerated the discomfort, quite typically treated with Tylenol,

Ibuprofen and ETOH (this is the oilpatch after all)

Day 3 increasing pain, pt. contacted myself, I assessed this fellow,

without shadow of doubt in a lot of discomfort, 9/10 for pain.

ps (I too have had some knitting done in my left AC joint, its major pain

and requiring LOTS of " Percocet/Oxycodone " why hurt when the great spirit

made the Opium poppy but then again I have a good GP and he drinks good

scotch too, I digress.

PE: Full range of motion, good distal pulses, extremity not cool to

touch, good cap refill but obvious decreased strength, complained of some

mild parenthesis to lateral aspect of triceps.

I send him into hospital with a driver 2 hours on very bumpy gravel road,

believing that he would return with better Rx than I have for moderate

pain relief. I only have Toradol for injection only (Rob makes a good

point sedation side effects by a Paramedic resulting in an injury = huge

liability issues)

So a resident MD " R2 on call " concurs with partial dislocation gives

patient x 6 Tylenol #3 (acetaminophen 500 mgs and 30mgs Codeine) pretty

much a waste of effort and no x-ray available, come back tomorrow ....

bump, bump back to site, with an even more upset patient.

Day 4: Patient calls ... I find patient in severe Pain .. enough is

enough .... smoke the sucker with 13 mgs MS over 3 hour period, small

increments IV Push to effect. I take him back, a supposedly real MD does

the 1 minute assessment on shoulder, locates 2 or three tiny pustules

(not vesicular in nature) on lateral aspect of upper arm .... diagnosis

in 4 minutes flat a new world record, should we tell him that they

appeared 4 days after the initial complaint and the patient was using a

Tiger Balm type rub possibly irritating the skin ? Nope to late for that

punt .... out the door.

Point is I have seen quite a few cases of shingles and had a bout with

them myself but typically a rash is observed midline spinal column

posterior with radiation around to anterior (dependant on Dermatome level

affected) and unilateral in majority of cases. Also the MD stated

dermatome " C2 level affected " , and this I know is crap, upper arm is C 4

or 5 !

So he writes a script for Acyclovir and Tramodol ... hence the my query.

I have never heard of this stuff so was wondering if anyone had any first

hand experience with it, I can read the literature but it states the T#3

are effective too... pfft, the only thing they do for me is get me

constipated and I can pop them like pez candies without any effect.

My conclusion: I send patient to a real hospital, the big city about 4

hours drive (family driving after the Morphine) so maybe some x-rays ? to

rule out AC partial separation ? Things like a temperature, ps I did not

because I believed I was looking at musculoskeletal situation, maybe a

CBC ... yea know like that medical stuff.

cheers

Wilf

Tramadol speak..!

What is AC separation....why does it need an X-ray and how is it related

to shingles pustules..?

Thanx

P

..

[Guest guest]

Wow Wilf you are hanging in well!. Lets hope they did a viral culture to " prove "

the Zoster.. and realized that they(Herpes Zoster and or AC seperation) ARE very

painful and Tramadol and T3 are poor pain meds for this in the acute phase.There

can be a post herpetic neuralgia and it will follow the dermatome and c5 is the

lateral triceps inervation... some c4 and some c6... having broken my neck  and

haveing had lare disc and centeral cord compression with refered pain to those

those area's and now havinh radiculopathy and neuopathy I'll hang my hat on

that... not C2.. anyway..you can diagnose AC seperation clinically and with

plain film but ahhh the MRI is so much nicer and then there is now doubt when

the patient claims that his injury was aggrevated or worsened...so. here's to

you, and a hope that it all ets straihtened out for the workers sake.

Gerry

From: H Dawdy <jdawdy@...>

Subject: Re: Tramadol speak..!

Date: Monday, October 13, 2008, 8:16 AM

Wilf,

Maybe other here can give a better idea, but every time I have used tramadol I

have not been terribly impressed with it. From my purely subjective view, it

seems to be about the equivalent of giving the patient some acetaminophen with

codeine (Tylenol 3), only in injectible form.

The Oxford League Table of Analgesics http://www.medicine .ox.ac.uk/ bandolier/

booth/painpag/ Acutrev/Analgesi cs/Leagtab. html seems to bear this out.

Jim

----- Start Original Message -----

Sent: Sun, 12 Oct 2008 22:07:58 -0600

From: " Wilf Mackie " <w.mackietelus (DOT) net>

< @groups. com>

Subject: Re: [Remotemedics. co.uk] Tramadol speak..!

>

> et all:

Firstly thanks for all the info ... sans the Lemon Cocco Butter

applications eeuwww, my eyes watered.

I suspect I should explain the presenting patient.

PMHX: 48 y/o, Male, not on routine rx, no allergies.

C/C: Onset of pain to mod to severe pain to left shoulder while taking

off his shirt 4 days ago, with chronic acromioclavicular dislocations

noted from his history. Patient states " it went out, then in " and for 2

days tolerated the discomfort, quite typically treated with Tylenol,

Ibuprofen and ETOH (this is the oilpatch after all)

Day 3 increasing pain, pt. contacted myself, I assessed this fellow,

without shadow of doubt in a lot of discomfort, 9/10 for pain.

ps (I too have had some knitting done in my left AC joint, its major pain

and requiring LOTS of " Percocet/Oxycodone " why hurt when the great spirit

made the Opium poppy but then again I have a good GP and he drinks good

scotch too, I digress.

PE: Full range of motion, good distal pulses, extremity not cool to

touch, good cap refill but obvious decreased strength, complained of some

mild parenthesis to lateral aspect of triceps.

I send him into hospital with a driver 2 hours on very bumpy gravel road,

believing that he would return with better Rx than I have for moderate

pain relief. I only have Toradol for injection only (Rob makes a good

point sedation side effects by a Paramedic resulting in an injury = huge

liability issues)

So a resident MD " R2 on call " concurs with partial dislocation gives

patient x 6 Tylenol #3 (acetaminophen 500 mgs and 30mgs Codeine) pretty

much a waste of effort and no x-ray available, come back tomorrow ....

bump, bump back to site, with an even more upset patient.

Day 4: Patient calls ... I find patient in severe Pain .. enough is

enough .... smoke the sucker with 13 mgs MS over 3 hour period, small

increments IV Push to effect. I take him back, a supposedly real MD does

the 1 minute assessment on shoulder, locates 2 or three tiny pustules

(not vesicular in nature) on lateral aspect of upper arm .... diagnosis

in 4 minutes flat a new world record, should we tell him that they

appeared 4 days after the initial complaint and the patient was using a

Tiger Balm type rub possibly irritating the skin ? Nope to late for that

punt .... out the door.

Point is I have seen quite a few cases of shingles and had a bout with

them myself but typically a rash is observed midline spinal column

posterior with radiation around to anterior (dependant on Dermatome level

affected) and unilateral in majority of cases. Also the MD stated

dermatome " C2 level affected " , and this I know is crap, upper arm is C 4

or 5 !

So he writes a script for Acyclovir and Tramodol ... hence the my query.

I have never heard of this stuff so was wondering if anyone had any first

hand experience with it, I can read the literature but it states the T#3

are effective too... pfft, the only thing they do for me is get me

constipated and I can pop them like pez candies without any effect.

My conclusion: I send patient to a real hospital, the big city about 4

hours drive (family driving after the Morphine) so maybe some x-rays ? to

rule out AC partial separation ? Things like a temperature, ps I did not

because I believed I was looking at musculoskeletal situation, maybe a

CBC ... yea know like that medical stuff.

cheers

Wilf

[Remotemedics. co.uk] Tramadol speak..!

What is AC separation.. ..why does it need an X-ray and how is it related

to shingles pustules..?

Thanx

P

..

[Guest guest]

Nope no blood work done, at all.

The fastest dx I have ever seen ..

I am going to call the " Doc faster than the speed of light, more powerful than a

locomotive "

Thing is the patient knows that I did my best for him, and he was no abuser.

cheers

Wilf

Re: Tramadol speak..!

Wow Wilf you are hanging in well!. Lets hope they did a viral culture to

" prove " the Zoster.. and realized that they(Herpes Zoster and or AC seperation)

ARE very painful and Tramadol and T3 are poor pain meds for this in the acute

phase.There can be a post herpetic neuralgia and it will follow the dermatome

and c5 is the lateral triceps inervation... some c4 and some c6... having broken

my neck and haveing had lare disc and centeral cord compression with refered

pain to those those area's and now havinh radiculopathy and neuopathy I'll hang

my hat on that... not C2.. anyway..you can diagnose AC seperation clinically and

with plain film but ahhh the MRI is so much nicer and then there is now doubt

when the patient claims that his injury was aggrevated or worsened...so. here's

to you, and a hope that it all ets straihtened out for the workers sake.

Gerry

.

[Guest guest]

Well hang in.Here's hoping the fella does well.

Thanks for the group stimulation though!It was good for me..hope it was good for

you:).

Gerry

From: Wilf Mackie <w.mackie@...>

Subject: Re: Tramadol speak..!

Date: Tuesday, October 14, 2008, 4:11 PM

Nope no blood work done, at all.

The fastest dx I have ever seen ..

I am going to call the " Doc faster than the speed of light, more powerful than a

locomotive "

Thing is the patient knows that I did my best for him, and he was no abuser.

cheers

Wilf

Re: [Remotemedics. co.uk] Tramadol speak..!

Wow Wilf you are hanging in well!. Lets hope they did a viral culture to " prove "

the Zoster.. and realized that they(Herpes Zoster and or AC seperation) ARE very

painful and Tramadol and T3 are poor pain meds for this in the acute phase.There

can be a post herpetic neuralgia and it will follow the dermatome and c5 is the

lateral triceps inervation.. . some c4 and some c6... having broken my neck and

haveing had lare disc and centeral cord compression with refered pain to those

those area's and now havinh radiculopathy and neuopathy I'll hang my hat on

that... not C2.. anyway..you can diagnose AC seperation clinically and with

plain film but ahhh the MRI is so much nicer and then there is now doubt when

the patient claims that his injury was aggrevated or worsened...so. here's to

you, and a hope that it all ets straihtened out for the workers sake.

Gerry

..

[Guest guest]

Gerry:

I am all about mutual gratification ;>))

Should I tell you about the compartment syndrome I had last week just prior to

this incident and delayed medical care because a threat of job loss ... sorry

can't do that, that scenario it one will be going to the lawyers right quick, ah

the life of a remote medic aint it grand, frankly this stuff is easy. Its the

Nazi cook that has a soft spot for me thats is my biggest fear lately .... oh

Helga .

cheers

Wilf hiding and typing under a rock in the patch.

Re: Tramadol speak..!

Well hang in.Here's hoping the fella does well.

Thanks for the group stimulation though!It was good for me..hope it was good

for you:).

Gerry

.

[Guest guest]

You don't necessarily have to be as remote as you are to meet and " dance " with

the dummies....Good luck on the weinerschizle(spellin? )

Gerry

From: Wilf Mackie <w.mackie@...>

Subject: Re: Tramadol speak..!

Date: Wednesday, October 15, 2008, 5:37 PM

Gerry:

I am all about mutual gratification ;>))

Should I tell you about the compartment syndrome I had last week just prior to

this incident and delayed medical care because a threat of job loss ... sorry

can't do that, that scenario it one will be going to the lawyers right quick, ah

the life of a remote medic aint it grand, frankly this stuff is easy. Its the

Nazi cook that has a soft spot for me thats is my biggest fear lately .... oh

Helga .

cheers

Wilf hiding and typing under a rock in the patch.

Re: [Remotemedics. co.uk] Tramadol speak..!

Well hang in.Here's hoping the fella does well.

Thanks for the group stimulation though!It was good for me..hope it was good for

you:).

Gerry

..