Guest guest Posted December 5, 2011 Report Share Posted December 5, 2011 -- Here or some answers Dudman and yes I too, am looking forward to what others have to say  I have a question I hope will spur some conversation on this bright Monday morning. Part of determining a patient's level of consciousness is their level of alertness. If they are not visibly awake, and they do not respond to voice commands, then it is time to see if pain can elicit a response. My questions are: 1. What is the latest and greatest in how to subject the patient to pain, what is/are the technique(s) and duration of performing the action?  Do not know 2. Does your agency have this spelled out in protocols or is it just what the medic feels is appropriate? I have seen it in some protocols but they have always been on the vague side, might read,' use minor force to determine response' 3. Have you ever seen someone use a test for pain response to determine if the patient is " faking " their symptoms? (and if so, is this addressed in protocol?) Yes, I have but no it was in the protocols. It was learned from experience 4. For whatever technique(s) you use, do you know of any science that backs up that technique as an appropriate way to actually test for what it is you are testing for? Do not know of any science just personal observation. The long used steranl rub, or the best one that I have used is the response from checking the BGL and the finger stick. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 5, 2011 Report Share Posted December 5, 2011 In the past I have seen people use ammonia caps placed inside a non-rebreather mask to " determine who is faking. " I have written and railed about this for years as (1) being dangerous to folks who may have reactive airway disease, (2) sadistic, (3) ineffective for those who are actually experts in feigning unresponsiveness and (4) utterly devoid of support as a technique in the medical literature. Yet I have had at least one prominent medical director attempt to defend the practice and the fact that ammonia caps were in his service's formulary to be used to " determine unresponsiveness. " I view this as being sadistic, punitive, and absolutely outside of acceptable standards of care. I teach that under no circumstances should this be done. As for determining level of consciousness, there are several benign ways to do it that involve no torture. One is simply tickling nose hairs with the corner of a 4 x 4 pad; another is insertion, if not contraindicated by injury, raising the patient's knees together to the flexed position and then letting them go. If the patient is truly unconscious, the knees will " splay " and not maintain their position. However, these are purely empiric measures and I have no medical research to cite supporting them. GG Question on Pain I have a question I hope will spur some conversation on this bright Monday morning. Part of determining a patient's level of consciousness is their level of alertness. If they are not visibly awake, and they do not respond to voice commands, then it is time to see if pain can elicit a response. My questions are: 1. What is the latest and greatest in how to subject the patient to pain, what is/are the technique(s) and duration of performing the action? 2. Does your agency have this spelled out in protocols or is it just what the medic feels is appropriate? 3. Have you ever seen someone use a test for pain response to determine if the patient is " faking " their symptoms? (and if so, is this addressed in protocol?) 4. For whatever technique(s) you use, do you know of any science that backs up that technique as an appropriate way to actually test for what it is you are testing for? C'mon on now...I haven't been on here in a while, but I really want to see what is being taught and performed now a days. Dudley Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 5, 2011 Report Share Posted December 5, 2011 In the past I have seen people use ammonia caps placed inside a non-rebreather mask to " determine who is faking. " I have written and railed about this for years as (1) being dangerous to folks who may have reactive airway disease, (2) sadistic, (3) ineffective for those who are actually experts in feigning unresponsiveness and (4) utterly devoid of support as a technique in the medical literature. Yet I have had at least one prominent medical director attempt to defend the practice and the fact that ammonia caps were in his service's formulary to be used to " determine unresponsiveness. " I view this as being sadistic, punitive, and absolutely outside of acceptable standards of care. I teach that under no circumstances should this be done. As for determining level of consciousness, there are several benign ways to do it that involve no torture. One is simply tickling nose hairs with the corner of a 4 x 4 pad; another is insertion, if not contraindicated by injury, raising the patient's knees together to the flexed position and then letting them go. If the patient is truly unconscious, the knees will " splay " and not maintain their position. However, these are purely empiric measures and I have no medical research to cite supporting them. GG Question on Pain I have a question I hope will spur some conversation on this bright Monday morning. Part of determining a patient's level of consciousness is their level of alertness. If they are not visibly awake, and they do not respond to voice commands, then it is time to see if pain can elicit a response. My questions are: 1. What is the latest and greatest in how to subject the patient to pain, what is/are the technique(s) and duration of performing the action? 2. Does your agency have this spelled out in protocols or is it just what the medic feels is appropriate? 3. Have you ever seen someone use a test for pain response to determine if the patient is " faking " their symptoms? (and if so, is this addressed in protocol?) 4. For whatever technique(s) you use, do you know of any science that backs up that technique as an appropriate way to actually test for what it is you are testing for? C'mon on now...I haven't been on here in a while, but I really want to see what is being taught and performed now a days. Dudley Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 5, 2011 Report Share Posted December 5, 2011 Not to defend or get into an argument, one of my early EMT (circa 1981) instructors related doing the ammonia cap trick (in his cupped hand, not a mask) and whispered into the teenager’s ear, “I can old this longer than you can.†He said that teen suddenly became fully alert and responsive. Never did determine if the youth reacted to the audible or olfactory stimulus. Barry Sharp, MSHP, MCHES Tobacco Prevention & Control Program Coordinator Substance Abuse Services Unit Mental Health and Substance Abuse Division From: texasems-l [mailto:texasems-l ] On Behalf Of Wegandy Sent: Monday, December 05, 2011 3:54 PM To: texasems-l Subject: Re: Question on Pain In the past I have seen people use ammonia caps placed inside a non-rebreather mask to " determine who is faking. " I have written and railed about this for years as (1) being dangerous to folks who may have reactive airway disease, (2) sadistic, (3) ineffective for those who are actually experts in feigning unresponsiveness and (4) utterly devoid of support as a technique in the medical literature. Yet I have had at least one prominent medical director attempt to defend the practice and the fact that ammonia caps were in his service's formulary to be used to " determine unresponsiveness. " I view this as being sadistic, punitive, and absolutely outside of acceptable standards of care. I teach that under no circumstances should this be done. As for determining level of consciousness, there are several benign ways to do it that involve no torture. One is simply tickling nose hairs with the corner of a 4 x 4 pad; another is insertion, if not contraindicated by injury, raising the patient's knees together to the flexed position and then letting them go. If the patient is truly unconscious, the knees will " splay " and not maintain their position. However, these are purely empiric measures and I have no medical research to cite supporting them. GG Question on Pain I have a question I hope will spur some conversation on this bright Monday morning. Part of determining a patient's level of consciousness is their level of alertness. If they are not visibly awake, and they do not respond to voice commands, then it is time to see if pain can elicit a response. My questions are: 1. What is the latest and greatest in how to subject the patient to pain, what is/are the technique(s) and duration of performing the action? 2. Does your agency have this spelled out in protocols or is it just what the medic feels is appropriate? 3. Have you ever seen someone use a test for pain response to determine if the patient is " faking " their symptoms? (and if so, is this addressed in protocol?) 4. For whatever technique(s) you use, do you know of any science that backs up that technique as an appropriate way to actually test for what it is you are testing for? C'mon on now...I haven't been on here in a while, but I really want to see what is being taught and performed now a days. Dudley Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 5, 2011 Report Share Posted December 5, 2011 Not to defend or get into an argument, one of my early EMT (circa 1981) instructors related doing the ammonia cap trick (in his cupped hand, not a mask) and whispered into the teenager’s ear, “I can old this longer than you can.†He said that teen suddenly became fully alert and responsive. Never did determine if the youth reacted to the audible or olfactory stimulus. Barry Sharp, MSHP, MCHES Tobacco Prevention & Control Program Coordinator Substance Abuse Services Unit Mental Health and Substance Abuse Division From: texasems-l [mailto:texasems-l ] On Behalf Of Wegandy Sent: Monday, December 05, 2011 3:54 PM To: texasems-l Subject: Re: Question on Pain In the past I have seen people use ammonia caps placed inside a non-rebreather mask to " determine who is faking. " I have written and railed about this for years as (1) being dangerous to folks who may have reactive airway disease, (2) sadistic, (3) ineffective for those who are actually experts in feigning unresponsiveness and (4) utterly devoid of support as a technique in the medical literature. Yet I have had at least one prominent medical director attempt to defend the practice and the fact that ammonia caps were in his service's formulary to be used to " determine unresponsiveness. " I view this as being sadistic, punitive, and absolutely outside of acceptable standards of care. I teach that under no circumstances should this be done. As for determining level of consciousness, there are several benign ways to do it that involve no torture. One is simply tickling nose hairs with the corner of a 4 x 4 pad; another is insertion, if not contraindicated by injury, raising the patient's knees together to the flexed position and then letting them go. If the patient is truly unconscious, the knees will " splay " and not maintain their position. However, these are purely empiric measures and I have no medical research to cite supporting them. GG Question on Pain I have a question I hope will spur some conversation on this bright Monday morning. Part of determining a patient's level of consciousness is their level of alertness. If they are not visibly awake, and they do not respond to voice commands, then it is time to see if pain can elicit a response. My questions are: 1. What is the latest and greatest in how to subject the patient to pain, what is/are the technique(s) and duration of performing the action? 2. Does your agency have this spelled out in protocols or is it just what the medic feels is appropriate? 3. Have you ever seen someone use a test for pain response to determine if the patient is " faking " their symptoms? (and if so, is this addressed in protocol?) 4. For whatever technique(s) you use, do you know of any science that backs up that technique as an appropriate way to actually test for what it is you are testing for? C'mon on now...I haven't been on here in a while, but I really want to see what is being taught and performed now a days. Dudley Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 5, 2011 Report Share Posted December 5, 2011 Dudley, My service specifies that pain responses are not allowed, and directly prohibits arm drops, pens on the nail beds, ammonia inhalants in O2 masks, and sternal rubs. Non-responsive patients are checked using " shake and shout, " increased level of voice, and if there appears to be no responsiveness, the airway is protected using an OPA. If your sadistic side doesn't feel the need to wake up every charlatan with the PVC challenge, another non-pain stimuli I can recommend is the eyelid flutter. Have someone close their eyes, and gently brush their eyelids. The flutter you see is very difficult to control in the conscious patient, especially if not expected. I have no science to back this one up, but it works very well. - Brad > > Subject: Question on Pain > To: texasems-l > Date: Monday, December 5, 2011, 9:32 AM > > I have a question I hope will spur some conversation on > this bright Monday morning. > > Part of determining a patient's level of consciousness is > their level of alertness. If they are not visibly > awake, and they do not respond to voice commands, then it is > time to see if pain can elicit a response. > > My questions are: > > 1. What is the latest and greatest in how to subject the > patient to pain, what is/are the technique(s) and duration > of performing the action? > 2. Does your agency have this spelled out in protocols or > is it just what the medic feels is appropriate? > 3. Have you ever seen someone use a test for pain > response to determine if the patient is " faking " their > symptoms? (and if so, is this addressed in protocol?) > 4. For whatever technique(s) you use, do you know of > any science that backs up that technique as an appropriate > way to actually test for what it is you are testing for? > > C'mon on now...I haven't been on here in a while, but I > really want to see what is being taught and performed now a > days. > > Dudley > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 5, 2011 Report Share Posted December 5, 2011 Dudley, My service specifies that pain responses are not allowed, and directly prohibits arm drops, pens on the nail beds, ammonia inhalants in O2 masks, and sternal rubs. Non-responsive patients are checked using " shake and shout, " increased level of voice, and if there appears to be no responsiveness, the airway is protected using an OPA. If your sadistic side doesn't feel the need to wake up every charlatan with the PVC challenge, another non-pain stimuli I can recommend is the eyelid flutter. Have someone close their eyes, and gently brush their eyelids. The flutter you see is very difficult to control in the conscious patient, especially if not expected. I have no science to back this one up, but it works very well. - Brad > > Subject: Question on Pain > To: texasems-l > Date: Monday, December 5, 2011, 9:32 AM > > I have a question I hope will spur some conversation on > this bright Monday morning. > > Part of determining a patient's level of consciousness is > their level of alertness. If they are not visibly > awake, and they do not respond to voice commands, then it is > time to see if pain can elicit a response. > > My questions are: > > 1. What is the latest and greatest in how to subject the > patient to pain, what is/are the technique(s) and duration > of performing the action? > 2. Does your agency have this spelled out in protocols or > is it just what the medic feels is appropriate? > 3. Have you ever seen someone use a test for pain > response to determine if the patient is " faking " their > symptoms? (and if so, is this addressed in protocol?) > 4. For whatever technique(s) you use, do you know of > any science that backs up that technique as an appropriate > way to actually test for what it is you are testing for? > > C'mon on now...I haven't been on here in a while, but I > really want to see what is being taught and performed now a > days. > > Dudley > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 5, 2011 Report Share Posted December 5, 2011 Today's VOICE OF REASON AWARD goes to Brad! GG Question on Pain > To: texasems-l > Date: Monday, December 5, 2011, 9:32 AM > > I have a question I hope will spur some conversation on > this bright Monday morning. > > Part of determining a patient's level of consciousness is > their level of alertness. If they are not visibly > awake, and they do not respond to voice commands, then it is > time to see if pain can elicit a response. > > My questions are: > > 1. What is the latest and greatest in how to subject the > patient to pain, what is/are the technique(s) and duration > of performing the action? > 2. Does your agency have this spelled out in protocols or > is it just what the medic feels is appropriate? > 3. Have you ever seen someone use a test for pain > response to determine if the patient is " faking " their > symptoms? (and if so, is this addressed in protocol?) > 4. For whatever technique(s) you use, do you know of > any science that backs up that technique as an appropriate > way to actually test for what it is you are testing for? > > C'mon on now...I haven't been on here in a while, but I > really want to see what is being taught and performed now a > days. > > Dudley > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 5, 2011 Report Share Posted December 5, 2011 Gene, I try to teach the airway progression technique. One of the main purposes in eliciting a response it to determine if they have control of there airway. We teach modified jaw thrust, then NPA, if still no response, OPA, and then finally intubation. This serves a direct purpose as opposed to the sternum rub or nail bed pressure methods of simply causing a patient pain.. > Today's VOICE OF REASON AWARD goes to Brad! > > GG > > Question on Pain > > To: texasems-l > > Date: Monday, December 5, 2011, 9:32 AM > > > > I have a question I hope will spur some conversation on > > this bright Monday morning. > > > > Part of determining a patient's level of consciousness is > > their level of alertness. If they are not visibly > > awake, and they do not respond to voice commands, then it is > > time to see if pain can elicit a response. > > > > My questions are: > > > > 1. What is the latest and greatest in how to subject the > > patient to pain, what is/are the technique(s) and duration > > of performing the action? > > 2. Does your agency have this spelled out in protocols or > > is it just what the medic feels is appropriate? > > 3. Have you ever seen someone use a test for pain > > response to determine if the patient is " faking " their > > symptoms? (and if so, is this addressed in protocol?) > > 4. For whatever technique(s) you use, do you know of > > any science that backs up that technique as an appropriate > > way to actually test for what it is you are testing for? > > > > C'mon on now...I haven't been on here in a while, but I > > really want to see what is being taught and performed now a > > days. > > > > Dudley > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 5, 2011 Report Share Posted December 5, 2011 I do the shake and shout and the arm drop. No reason to sternal rub, pinch, ammonia cap, or anything else that causes pain. If you start to put an opa or npa in, which I beleive would be pretty standard for a set of protocols-weather advanced or basic level-for an unresponsive pt, if they are " faking " you will figure it out pretty quickly. Alot of this is common sense. I'm with the rest, no scientific evidence, just 13 years experience to back up what I think. > Gene, > > I try to teach the airway progression technique. One of the main purposes > in eliciting a response it to determine if they have control of there > airway. We teach modified jaw thrust, then NPA, if still no response, OPA, > and then finally intubation. This serves a direct purpose as opposed to > the sternum rub or nail bed pressure methods of simply causing a patient > pain.. > > > > > > > > Today's VOICE OF REASON AWARD goes to Brad! > > > > GG > > > > Question on Pain > > > To: texasems-l > > > Date: Monday, December 5, 2011, 9:32 AM > > > > > > I have a question I hope will spur some conversation on > > > this bright Monday morning. > > > > > > Part of determining a patient's level of consciousness is > > > their level of alertness. If they are not visibly > > > awake, and they do not respond to voice commands, then it is > > > time to see if pain can elicit a response. > > > > > > My questions are: > > > > > > 1. What is the latest and greatest in how to subject the > > > patient to pain, what is/are the technique(s) and duration > > > of performing the action? > > > 2. Does your agency have this spelled out in protocols or > > > is it just what the medic feels is appropriate? > > > 3. Have you ever seen someone use a test for pain > > > response to determine if the patient is " faking " their > > > symptoms? (and if so, is this addressed in protocol?) > > > 4. For whatever technique(s) you use, do you know of > > > any science that backs up that technique as an appropriate > > > way to actually test for what it is you are testing for? > > > > > > C'mon on now...I haven't been on here in a while, but I > > > really want to see what is being taught and performed now a > > > days. > > > > > > Dudley > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 5, 2011 Report Share Posted December 5, 2011 I do the shake and shout and the arm drop. No reason to sternal rub, pinch, ammonia cap, or anything else that causes pain. If you start to put an opa or npa in, which I beleive would be pretty standard for a set of protocols-weather advanced or basic level-for an unresponsive pt, if they are " faking " you will figure it out pretty quickly. Alot of this is common sense. I'm with the rest, no scientific evidence, just 13 years experience to back up what I think. > Gene, > > I try to teach the airway progression technique. One of the main purposes > in eliciting a response it to determine if they have control of there > airway. We teach modified jaw thrust, then NPA, if still no response, OPA, > and then finally intubation. This serves a direct purpose as opposed to > the sternum rub or nail bed pressure methods of simply causing a patient > pain.. > > > > > > > > Today's VOICE OF REASON AWARD goes to Brad! > > > > GG > > > > Question on Pain > > > To: texasems-l > > > Date: Monday, December 5, 2011, 9:32 AM > > > > > > I have a question I hope will spur some conversation on > > > this bright Monday morning. > > > > > > Part of determining a patient's level of consciousness is > > > their level of alertness. If they are not visibly > > > awake, and they do not respond to voice commands, then it is > > > time to see if pain can elicit a response. > > > > > > My questions are: > > > > > > 1. What is the latest and greatest in how to subject the > > > patient to pain, what is/are the technique(s) and duration > > > of performing the action? > > > 2. Does your agency have this spelled out in protocols or > > > is it just what the medic feels is appropriate? > > > 3. Have you ever seen someone use a test for pain > > > response to determine if the patient is " faking " their > > > symptoms? (and if so, is this addressed in protocol?) > > > 4. For whatever technique(s) you use, do you know of > > > any science that backs up that technique as an appropriate > > > way to actually test for what it is you are testing for? > > > > > > C'mon on now...I haven't been on here in a while, but I > > > really want to see what is being taught and performed now a > > > days. > > > > > > Dudley > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 5, 2011 Report Share Posted December 5, 2011 Interesting replies so far... Gene, so the sternal rub is no longer taught in an attempt to determine if the patient is awake or not? Do you still teach the GCS and if so, how do you teach the students to determine the patient's best motor response when it comes to localizes pain or withdraws from pain? I read a handful of interesting articles regarding this...one that said doing a pain stimulus on the extremities could actually cause a reflex response and not give a true neurological sign. It then went on to recommend one of three tests done on the core of the patient. 1. Sternal rub (but it cautioned that neurology studies show it should be done for 30 seconds...) 2. Pinching the trapezius muscle at the base of the neck between your thumb and forefinger; and 3. applying pressure to the orbital border above the eye. I do believe there are times where it is necessary to determine a patient's response to pain...and I believe our colleagues in neurology (if we can call them colleagues could help us with 2-3 options that are bona fide methods, possibly proven by science. Now, this being said, I like your term " torture " ...and that is one of the reasons I asked this question. When and where did it become acceptable to assume patients are " faking it " until proven otherwise? It isn't just the unconscious patient...but the person with back pain a 10 of 10 who is now a drug seeker or the seizure patient that doesn't have a grand mal seizure is having " pseudo " seizures....where else does this list go? It really is a simple change of philosophy...but my concern is it has grown out of an education system that utilizes the best war story teller who loves to regale the " young skulls full of mush " with story after story of how he/she found another " drug seeker " or determined that the unconscious patient was " faking it " by attempting to drop their forearm on their face and they are looked at in awe and amazement because they " know so much " . I have seen an amazing number of such cases. I have seen the arm drop go horribly wrong when the arm landed on the patient's nose, causing bleeding...so not only did we have an unconscious patient, but now we had an airway compromise. I have seen medics attempt to write off a patient's signs and symptoms because the patient had anxiety, even though the monitor showed narrow complex tachycardia over 200 bpm. Or the reverse of all this...a paramedic calls the service he works for because he is having back pain. He has a long history of back problems, is on some pretty good prescription pain meds which aren't working currently and he needs to go to the ED for better pain relief...but despite not treating a nearly identical patient earlier in their shift for the back pain because he was a drug seeker...the medic got enough Fentanyl to snow an elephant. So, I guess my follow up questions are where does this attitude come from? Why do we no longer believe our patients? Why do we feel it is our job to prove that our patient's complaints are not true or valid? Even though we appear to developing a much more in depth education process, those that are coming out of it appear more jaded and skeptical of their patient's story than many I know who have been doing this for 15+ years. Thoughts??? Dudley Question on Pain I have a question I hope will spur some conversation on this bright Monday morning. Part of determining a patient's level of consciousness is their level of alertness. If they are not visibly awake, and they do not respond to voice commands, then it is time to see if pain can elicit a response. My questions are: 1. What is the latest and greatest in how to subject the patient to pain, what is/are the technique(s) and duration of performing the action? 2. Does your agency have this spelled out in protocols or is it just what the medic feels is appropriate? 3. Have you ever seen someone use a test for pain response to determine if the patient is " faking " their symptoms? (and if so, is this addressed in protocol?) 4. For whatever technique(s) you use, do you know of any science that backs up that technique as an appropriate way to actually test for what it is you are testing for? C'mon on now...I haven't been on here in a while, but I really want to see what is being taught and performed now a days. Dudley Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 5, 2011 Report Share Posted December 5, 2011 Interesting replies so far... Gene, so the sternal rub is no longer taught in an attempt to determine if the patient is awake or not? Do you still teach the GCS and if so, how do you teach the students to determine the patient's best motor response when it comes to localizes pain or withdraws from pain? I read a handful of interesting articles regarding this...one that said doing a pain stimulus on the extremities could actually cause a reflex response and not give a true neurological sign. It then went on to recommend one of three tests done on the core of the patient. 1. Sternal rub (but it cautioned that neurology studies show it should be done for 30 seconds...) 2. Pinching the trapezius muscle at the base of the neck between your thumb and forefinger; and 3. applying pressure to the orbital border above the eye. I do believe there are times where it is necessary to determine a patient's response to pain...and I believe our colleagues in neurology (if we can call them colleagues could help us with 2-3 options that are bona fide methods, possibly proven by science. Now, this being said, I like your term " torture " ...and that is one of the reasons I asked this question. When and where did it become acceptable to assume patients are " faking it " until proven otherwise? It isn't just the unconscious patient...but the person with back pain a 10 of 10 who is now a drug seeker or the seizure patient that doesn't have a grand mal seizure is having " pseudo " seizures....where else does this list go? It really is a simple change of philosophy...but my concern is it has grown out of an education system that utilizes the best war story teller who loves to regale the " young skulls full of mush " with story after story of how he/she found another " drug seeker " or determined that the unconscious patient was " faking it " by attempting to drop their forearm on their face and they are looked at in awe and amazement because they " know so much " . I have seen an amazing number of such cases. I have seen the arm drop go horribly wrong when the arm landed on the patient's nose, causing bleeding...so not only did we have an unconscious patient, but now we had an airway compromise. I have seen medics attempt to write off a patient's signs and symptoms because the patient had anxiety, even though the monitor showed narrow complex tachycardia over 200 bpm. Or the reverse of all this...a paramedic calls the service he works for because he is having back pain. He has a long history of back problems, is on some pretty good prescription pain meds which aren't working currently and he needs to go to the ED for better pain relief...but despite not treating a nearly identical patient earlier in their shift for the back pain because he was a drug seeker...the medic got enough Fentanyl to snow an elephant. So, I guess my follow up questions are where does this attitude come from? Why do we no longer believe our patients? Why do we feel it is our job to prove that our patient's complaints are not true or valid? Even though we appear to developing a much more in depth education process, those that are coming out of it appear more jaded and skeptical of their patient's story than many I know who have been doing this for 15+ years. Thoughts??? Dudley Question on Pain I have a question I hope will spur some conversation on this bright Monday morning. Part of determining a patient's level of consciousness is their level of alertness. If they are not visibly awake, and they do not respond to voice commands, then it is time to see if pain can elicit a response. My questions are: 1. What is the latest and greatest in how to subject the patient to pain, what is/are the technique(s) and duration of performing the action? 2. Does your agency have this spelled out in protocols or is it just what the medic feels is appropriate? 3. Have you ever seen someone use a test for pain response to determine if the patient is " faking " their symptoms? (and if so, is this addressed in protocol?) 4. For whatever technique(s) you use, do you know of any science that backs up that technique as an appropriate way to actually test for what it is you are testing for? C'mon on now...I haven't been on here in a while, but I really want to see what is being taught and performed now a days. Dudley Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 5, 2011 Report Share Posted December 5, 2011 I agree with Gene, Brad. Thanks for the information. Dudley Question on Pain > To: texasems-l > Date: Monday, December 5, 2011, 9:32 AM > > I have a question I hope will spur some conversation on > this bright Monday morning. > > Part of determining a patient's level of consciousness is > their level of alertness. If they are not visibly > awake, and they do not respond to voice commands, then it is > time to see if pain can elicit a response. > > My questions are: > > 1. What is the latest and greatest in how to subject the > patient to pain, what is/are the technique(s) and duration > of performing the action? > 2. Does your agency have this spelled out in protocols or > is it just what the medic feels is appropriate? > 3. Have you ever seen someone use a test for pain > response to determine if the patient is " faking " their > symptoms? (and if so, is this addressed in protocol?) > 4. For whatever technique(s) you use, do you know of > any science that backs up that technique as an appropriate > way to actually test for what it is you are testing for? > > C'mon on now...I haven't been on here in a while, but I > really want to see what is being taught and performed now a > days. > > Dudley > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 5, 2011 Report Share Posted December 5, 2011 I agree with Gene, Brad. Thanks for the information. Dudley Question on Pain > To: texasems-l > Date: Monday, December 5, 2011, 9:32 AM > > I have a question I hope will spur some conversation on > this bright Monday morning. > > Part of determining a patient's level of consciousness is > their level of alertness. If they are not visibly > awake, and they do not respond to voice commands, then it is > time to see if pain can elicit a response. > > My questions are: > > 1. What is the latest and greatest in how to subject the > patient to pain, what is/are the technique(s) and duration > of performing the action? > 2. Does your agency have this spelled out in protocols or > is it just what the medic feels is appropriate? > 3. Have you ever seen someone use a test for pain > response to determine if the patient is " faking " their > symptoms? (and if so, is this addressed in protocol?) > 4. For whatever technique(s) you use, do you know of > any science that backs up that technique as an appropriate > way to actually test for what it is you are testing for? > > C'mon on now...I haven't been on here in a while, but I > really want to see what is being taught and performed now a > days. > > Dudley > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 5, 2011 Report Share Posted December 5, 2011 Exactly. G Question on Pain > > To: texasems-l > > Date: Monday, December 5, 2011, 9:32 AM > > > > I have a question I hope will spur some conversation on > > this bright Monday morning. > > > > Part of determining a patient's level of consciousness is > > their level of alertness. If they are not visibly > > awake, and they do not respond to voice commands, then it is > > time to see if pain can elicit a response. > > > > My questions are: > > > > 1. What is the latest and greatest in how to subject the > > patient to pain, what is/are the technique(s) and duration > > of performing the action? > > 2. Does your agency have this spelled out in protocols or > > is it just what the medic feels is appropriate? > > 3. Have you ever seen someone use a test for pain > > response to determine if the patient is " faking " their > > symptoms? (and if so, is this addressed in protocol?) > > 4. For whatever technique(s) you use, do you know of > > any science that backs up that technique as an appropriate > > way to actually test for what it is you are testing for? > > > > C'mon on now...I haven't been on here in a while, but I > > really want to see what is being taught and performed now a > > days. > > > > Dudley > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 5, 2011 Report Share Posted December 5, 2011 Exactly. G Question on Pain > > To: texasems-l > > Date: Monday, December 5, 2011, 9:32 AM > > > > I have a question I hope will spur some conversation on > > this bright Monday morning. > > > > Part of determining a patient's level of consciousness is > > their level of alertness. If they are not visibly > > awake, and they do not respond to voice commands, then it is > > time to see if pain can elicit a response. > > > > My questions are: > > > > 1. What is the latest and greatest in how to subject the > > patient to pain, what is/are the technique(s) and duration > > of performing the action? > > 2. Does your agency have this spelled out in protocols or > > is it just what the medic feels is appropriate? > > 3. Have you ever seen someone use a test for pain > > response to determine if the patient is " faking " their > > symptoms? (and if so, is this addressed in protocol?) > > 4. For whatever technique(s) you use, do you know of > > any science that backs up that technique as an appropriate > > way to actually test for what it is you are testing for? > > > > C'mon on now...I haven't been on here in a while, but I > > really want to see what is being taught and performed now a > > days. > > > > Dudley > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 5, 2011 Report Share Posted December 5, 2011 I have taken the opportunity to insert some comments below. All will not find them to be entirely complementary of our profession. GG Question on Pain I have a question I hope will spur some conversation on this bright Monday morning. Part of determining a patient's level of consciousness is their level of alertness. If they are not visibly awake, and they do not respond to voice commands, then it is time to see if pain can elicit a response. My questions are: 1. What is the latest and greatest in how to subject the patient to pain, what is/are the technique(s) and duration of performing the action? 2. Does your agency have this spelled out in protocols or is it just what the medic feels is appropriate? 3. Have you ever seen someone use a test for pain response to determine if the patient is " faking " their symptoms? (and if so, is this addressed in protocol?) 4. For whatever technique(s) you use, do you know of any science that backs up that technique as an appropriate way to actually test for what it is you are testing for? C'mon on now...I haven't been on here in a while, but I really want to see what is being taught and performed now a days. Dudley Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 5, 2011 Report Share Posted December 5, 2011 I have taken the opportunity to insert some comments below. All will not find them to be entirely complementary of our profession. GG Question on Pain I have a question I hope will spur some conversation on this bright Monday morning. Part of determining a patient's level of consciousness is their level of alertness. If they are not visibly awake, and they do not respond to voice commands, then it is time to see if pain can elicit a response. My questions are: 1. What is the latest and greatest in how to subject the patient to pain, what is/are the technique(s) and duration of performing the action? 2. Does your agency have this spelled out in protocols or is it just what the medic feels is appropriate? 3. Have you ever seen someone use a test for pain response to determine if the patient is " faking " their symptoms? (and if so, is this addressed in protocol?) 4. For whatever technique(s) you use, do you know of any science that backs up that technique as an appropriate way to actually test for what it is you are testing for? C'mon on now...I haven't been on here in a while, but I really want to see what is being taught and performed now a days. Dudley Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 6, 2011 Report Share Posted December 6, 2011 Gene, while all of your thoughts are not always complimentary of our profession, they are filled with wisdom and thoughtfulness. And probably a lot more honesty than we are comfortable hearing. Thank you for sharing your insight. Barry Barry Sharp, MSHP, MCHES Tobacco Prevention & Control Program Coordinator Substance Abuse Services Unit Mental Health and Substance Abuse Division From: texasems-l [mailto:texasems-l ] On Behalf Of wegandy1938@... Sent: Monday, December 05, 2011 11:39 PM To: texasems-l Subject: Re: Question on Pain I have taken the opportunity to insert some comments below. All will not find them to be entirely complementary of our profession. GG Question on Pain I have a question I hope will spur some conversation on this bright Monday morning. Part of determining a patient's level of consciousness is their level of alertness. If they are not visibly awake, and they do not respond to voice commands, then it is time to see if pain can elicit a response. My questions are: 1. What is the latest and greatest in how to subject the patient to pain, what is/are the technique(s) and duration of performing the action? 2. Does your agency have this spelled out in protocols or is it just what the medic feels is appropriate? 3. Have you ever seen someone use a test for pain response to determine if the patient is " faking " their symptoms? (and if so, is this addressed in protocol?) 4. For whatever technique(s) you use, do you know of any science that backs up that technique as an appropriate way to actually test for what it is you are testing for? C'mon on now...I haven't been on here in a while, but I really want to see what is being taught and performed now a days. Dudley Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 6, 2011 Report Share Posted December 6, 2011 Gene, while all of your thoughts are not always complimentary of our profession, they are filled with wisdom and thoughtfulness. And probably a lot more honesty than we are comfortable hearing. Thank you for sharing your insight. Barry Barry Sharp, MSHP, MCHES Tobacco Prevention & Control Program Coordinator Substance Abuse Services Unit Mental Health and Substance Abuse Division From: texasems-l [mailto:texasems-l ] On Behalf Of wegandy1938@... Sent: Monday, December 05, 2011 11:39 PM To: texasems-l Subject: Re: Question on Pain I have taken the opportunity to insert some comments below. All will not find them to be entirely complementary of our profession. GG Question on Pain I have a question I hope will spur some conversation on this bright Monday morning. Part of determining a patient's level of consciousness is their level of alertness. If they are not visibly awake, and they do not respond to voice commands, then it is time to see if pain can elicit a response. My questions are: 1. What is the latest and greatest in how to subject the patient to pain, what is/are the technique(s) and duration of performing the action? 2. Does your agency have this spelled out in protocols or is it just what the medic feels is appropriate? 3. Have you ever seen someone use a test for pain response to determine if the patient is " faking " their symptoms? (and if so, is this addressed in protocol?) 4. For whatever technique(s) you use, do you know of any science that backs up that technique as an appropriate way to actually test for what it is you are testing for? C'mon on now...I haven't been on here in a while, but I really want to see what is being taught and performed now a days. Dudley Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 6, 2011 Report Share Posted December 6, 2011 Thats because Genes filter no longer works. When he speaks both the good and bad come out at the same time. I have a similiar filter issue myself. Henry Question on Pain I have a question I hope will spur some conversation on this bright Monday morning. Part of determining a patient's level of consciousness is their level of alertness. If they are not visibly awake, and they do not respond to voice commands, then it is time to see if pain can elicit a response. My questions are: 1. What is the latest and greatest in how to subject the patient to pain, what is/are the technique(s) and duration of performing the action? 2. Does your agency have this spelled out in protocols or is it just what the medic feels is appropriate? 3. Have you ever seen someone use a test for pain response to determine if the patient is " faking " their symptoms? (and if so, is this addressed in protocol?) 4. For whatever technique(s) you use, do you know of any science that backs up that technique as an appropriate way to actually test for what it is you are testing for? C'mon on now...I haven't been on here in a while, but I really want to see what is being taught and performed now a days. Dudley Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 6, 2011 Report Share Posted December 6, 2011 Thats because Genes filter no longer works. When he speaks both the good and bad come out at the same time. I have a similiar filter issue myself. Henry Question on Pain I have a question I hope will spur some conversation on this bright Monday morning. Part of determining a patient's level of consciousness is their level of alertness. If they are not visibly awake, and they do not respond to voice commands, then it is time to see if pain can elicit a response. My questions are: 1. What is the latest and greatest in how to subject the patient to pain, what is/are the technique(s) and duration of performing the action? 2. Does your agency have this spelled out in protocols or is it just what the medic feels is appropriate? 3. Have you ever seen someone use a test for pain response to determine if the patient is " faking " their symptoms? (and if so, is this addressed in protocol?) 4. For whatever technique(s) you use, do you know of any science that backs up that technique as an appropriate way to actually test for what it is you are testing for? C'mon on now...I haven't been on here in a while, but I really want to see what is being taught and performed now a days. Dudley Quote Link to comment Share on other sites More sharing options...
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