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Monday, February 8, 2010

50mg of Benadryl And Some Morphine

I just moved to a new station. My engineer bid out to the same station as me so we're still together. So while my captain, engineer and I were working out we talked about "frequent flyers" that are in the area. I've met a couple of them already from the overtime shifts that I've worked. My engineer mentions one that used to be in the area a while back but my captain says they haven't run on her in a long time.

Fast forward to lunch time. The tones go off and we are dispatched to a familiar address (at least to the rest of my crew). At my old station I would get dirty looks when I would say we hadn't had a certain type of call in a while. We would undoubtedly get on that shift. Full arrests, traffic accidents, wires down, didn't matter. Every once in a while it would strike me that we hadn't had a, fill in the nature of the call here, in a while. My crew would groan and say more or less, "SHUT UP." Well this time my engineer had done it. We were headed to the frequent flyer that my engineer had just told me about.
 When we arrived on scene we found a 28 year old female complaining of severe abdominal pain. When asked about her medical history she rattled off a list. She then informed me that she would like "50mg of Benadryl for her anxiety and some Morphine." Going into the call I was forewarned that she was a drug seeker. Even if I hadn't been, she asked for Morphine. Anyone that asks me for Morphine automatically is put into the category of drug seeker and I refuse. At that point my thorough assessment will determine if you really are in pain or just full of sh*t. I am very aggressive about pain management. This stems from me getting yelled at by my preceptor years ago when I wasn't going to give Morphine to a guy before I moved him.
I asked my patient to rate her pain on a scale of 1-10 if a 10 was the most pain she had ever been in. This is a funny thing that goes on in the medical profession. We always ask the patient to rate the pain. I generally don't care what they say their pain level is, their body language always tells me what I need to know. So why do we ask? I digress. My patient said it was a 10!" So I asked her if this was the single most painful event of her life. She looked at me as if I were stupid and said no. So I tried to explain further. Think of the most pain you have ever been in, that is a 10. How is this pain compared to that? "It's a 10" she said again still with that look of your an idiot plastered on her face. Really not the best tactic if you're trying to get some pain meds. At this point I gave up. She obviously isn't in much pain, if any at all. And she's been in the EMS world enough to know what we ask and how she can get drugs (at least from a new medic).

Needless to say, she got nothing from us, nothing from AMR and I'm willing to bet, nothing from the ER. I'm sure I'll be seeing her again.


brian said...

Yeah, we always jinx it by mentioning those frequent flyers!

Ambulance Driver said...

If ever you get one of those dehydrated and/or borderline hypotensive patients that needs pain relief, 50 mg of Benadryl and your morphine is a good combo.

The hypotension that results from morphine administration is a pure histamine reaction - hence Benadryl being very useful to help blunt those effects.

jackie25remi said...

thanks for your chart, and your story

jbw12soc said...

however, when a patient requests benadryl with their morphine, they are not worried about their blood pressure. The benadryl removes the unpleasant side effects, (flushing, nausea, light headedness) and lets the patient enjoy the unadulterated euphoria.

Er Doc

Anonymous said...

"We always ask the patient to rate the pain. I generally don't care what they say their pain level is, their body language always tells me what I need to know. So why do we ask? I digress."

how woudl ur boss feel if they saw that? cunt

Firefighter/Paramedic said...

My Chief is a medic as well and I think he would back me up 100%. I think you may have misunderstood what I was saying. I don't care what number they assign to their pain. My 4 may be your 10. The number is a waste of time but is used for paperwork. I treat my patient instead.

Anonymous said...

You have a God complex. It's not up to you to "decide" what a person's pain level is. "My 4 may be your 10". You're not the one in pain so you have no clue how bad their level is. You're what's wrong with the medical field nowadays-you don't listen to the patients and make assumptions based on how YOU judge a persons body language.

Firefighter/Paramedic said...

For you Mr. Anonymous.

Life More Simply said...

Hillarious, people. Hillarious! Your hate comments made me laugh out loud. Maybe you should join take an EMT class if you want so badly to make a difference in the world. LOL

And yeah, I think any of our supervisors would agree about the number thing.

Anonymous said...

Ever notice how alll fire departments are primarily white? Ocassional token non-white here or there, but it seems obvious they reserve these soft easy money spots for those who fit their ideal for their "fraternity".
And the pay/benefit package!!! This is an industry which needs privitization, let alone austerity.
If not for that family those three men would still be alive.
How many have to die? If anther loses his life will they stop?

Firefighter/Paramedic said...

huh? who died?

Shauna said...

As a nurse and a spine-pain patient, I have always disliked any of the pain rating scales that are available for patients to report their pain. Regardless of the situation, all pain is subjective, as we know, and after living and working in pain for decades, and after multiple Thoracic spine surgeries, etc., I know what it feels like to experience pain all over those charts. However, I will always remember my rotation in nursing school through the burn unit. The screams could be heard in the elevator before the doors opened to the floor. After that experience, I will never rate any pain a 10 (no matter how high I feel I am experiencing it) on a 1-10 scale. It can always, always be higher and I wish that patients could really get that through their heads.

I walked away from a rollover MVA many years ago, and I am nothing but blessed to still be here sharing this with you. Bless you, and ALL of those on the front lines of the medical system. You guys ROCK!

Firefighter/Paramedic said...

Shauna, thanks for sharing. Pain is a difficult thing for people to rate. In general, if you are in pain AND you don't BS me, I'm more than willing to help you out. I just get frustrated with the few people out there that think they can pull a fast one on me just to get a high.

Amanda Scruggs said...


I'm new to this site and so far I like what I see.. other than the usual bad mouthing disgruntled person who happened upon the page and comments about their dislikes instead of moving along to a different page where they could perhaps find something they do like. Wow that was a very long run on sentence... sorry about that. Anyways I wanted to say I completely agree with your pain assessment comment. I've been doing this for 14 years.. and understand where that comment comes from. First off let's add different ethnic backgrounds to the mix and that completely proves your case. You take a 30 year old Hispanic Female patient with abd pain. First the fact you even are transporting her is rare as they don't generally seek medical treat too often.. but I guarantee she wouldn't rate her pain higher than a 5!! Take a 30 year Caucasian female with the SAME EXACT medical condition and she would rate her pain much higher! THUS someone's 10 could easily be another person's 4. Now for my opinion not based on evidence... we always treat the patient not the "scale" just as we treat the patient not the monitor. You get in my ambulance and are rating your pain a 10.. yet your respiratory rate and pulse are within normal limits then something doesn't add up. We all know that the body with exhibit s/so change in response to pain.

Btw let it be know I'm a 32 yo Caucasian female so my facts or opinions were not due to my ethnicity.

Firefighter/Paramedic said...

Amanda, you're awesome. Thanks for reading.

ElleJay Volpe said...


Thank you for sharing your experiences. It's a very interesting read. I've had many a kind EMT take care of me in my lifetime, and I am quite thankful for it.

This is the only entry I've read of yours so far, and I do not know you, so I cannot pass any judgment on your character. I also was not there, so I cannot give my opinion on the situation from my point of view.

However, as a patient with mobility concerns and chronic pain issues, (managed by pain specialists) it's these type of views that make me not ask for or refuse pain medication in hospitals when I am admitted to the ER even when I need them because my medications, my age, even the way I dress (when I'm not working, frilly dresses/alternative) red flag medical professionals that I am a drug seeker. It does not matter that I am not a drug seeker, that I am intelligent and educated, a professional, and that my conditions are legitimate. (It's gone so far that my medical files are never far away.)

People with less chronic issues receive better care than I do simply because they are a different kind of person than I am, and they are not on these medications. (which by the way, aren't fun...I don't particularly like them. There's no high when you've been on low dose opioids for four years! You just feel a little more functional, nauseated, and itchy, but at least you get to feel human.)

Most new doctors I get, it's the same routine. First they are highly suspicious, then they figure out I'm legitimate, then either try to offer a lot of really useless things that don't make sense for my condition, say that I'm too complicated of a case and can't help me at all, or admit they don't know much about it and need to refer me up. (I dump my GPs like a heartbreaker. When you have a rare condition, it's not worth spending your time with someone who doesn't get it.)

So, as I'm sure you know, or if you didn't maybe you have a window into now, there is another significant and very relevant side to those of us young people on these medications. As you iterated, I hope with your years in the profession you can tell the difference. I agree that the number is irrelevant because pain is very subjective and difficult to measure.

If you are curious to learn about my condition, Klippel Trenaunay Syndrome and a little bit about what I do, please take a look at my website:

The blog is under "Making It", and the entry on KTS is one of the older entries, back a page or two.

~ElleJay Volpe

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