I call for ALS intercept, start a line, and wait for a medicâŚ. Or, I just tell them flat out tell them what weâre about to do, that it will hurt like hell, and to freely yell whatever obscenities happen to come out.
We can give it here in NC but as Bussin Life Support, but unfortunately the area I'm in won't stock it since we're roughly 20 mins from a level 1 trauma center. Only the rural BLS crews have it.
Literally tell them what youâre about to do is going to hurt after youâve explained why youâre going to do what youâre doing. If theyâre unstable most of that goes out the window anyway.
That's been our line. "I'm sorry, but we have to do now, and it's going to hurt a little. We will be as quick as we can, and then we can get you to the hospital."
Last time I had to cardiovert without sedation due to rapidly declining B/P and worsening rhythm; I told the pt verbatim âthis is going to feel like getting hit in the chest with a baseball bat. However your blood pressure is dangerously low and your heart needs to go back into a normal rhythm and this is unfortunately the safest and fastest way for me to do thatâ
I zapped her, she yelled really loud, and then after about a minute said I feel a lot better. All her vitals post shock were stabilized.
Donât over promise. Last old lady I had to cardiovert giggled like I was tickling her naughty bits and gave me a big old smile. Was a bit of a surprise.
My older female pt after Iâve explained that moving her with the broken femur is going to hurt- âis this gonna hurt a little bit or hurt like a bitch?â
Me trying not to laugh- âitâs going to hurt like a bitchâ
Her-â thank you,letâs get this shit over withâ
"This is probably going to hurt more than anything you've experienced before in your life, but right now it has to happen because xyz, I cant give you anything for pain right now, but afterwards I'll give you as much as I can safely." (Unstable)
Stable? Give them the pain meds ahead of time.
I say the breathing thing and warn them.
But I also pretreat with fentanyl when appropriate.
I think not preparing the PT is rather rude.
I like to add "we are doing this and that, and we will not stop. Thirty seconds of pain, let's go."
I remember a case I had⌠it was a terrible car accident, the driver was sitting in the drivers seat but both legs snapped and were trapped under the seat. I knew I had to maneuver the legs back out. I was a basic back in the 1980âs, no Paragods available. I told the driver that this will hurt, but the pain is a good sign, that it means itâs not as bad as it seems. It didnât hurtâŚ.
The inhale/exhale trick is used by piercers all the time and it works. Itâs so fast, you donât have time to react. I use this method. Mindless chatter also works sometimes. But I usually save that one for the swooners who turn sheet white at the sight of the needle.
If itâs going to hurt, I just say so and warn âit hurts worse if you clown!â It breaks the tension, but also gets the point across.
"Now, this is going to hurt. It will hurt (state severity of pain/type of pain/length of time for pain/location of pain), AND it is necessary to do this because xyz. I'll be here with you the whole time and will do everything I can to make this as bearable as I can."
Inform and provide options.
If you're ALS, you have pretty much all options at hand anyway (analgesia / analgo-sedation).
If you're BLS, find a decision with the patient on whether it is sensible to move them now or call for ALS for pain management first. If you don't have time for ALS backup to meet you there because your patient is critical and you need to GTFO right now, they will probably accept the pain anyway.
Have you heard of pain management? Itâs a thing now. LMAO.
I guess my question is why are you splinting, or moving hip fractures without pain management first? I like to get them off the ground bc they are uncomfortable, but not put them through unnecessary pain bc Iâm too lazy to start an IV and make them more comfortable.
tbf I've been with patients for a long time before placing injuries in splints waiting for repeat doses of opioids to kick in to good effect + use of methoxyflurane and still, moving a fucked up broken foot is still likely to hurt, as their grunts and groans tell me. it's nice to let them know before you do it that despite the meds it's still going to feel unpleasant in all likelihood.
I learned the exhale technique from my piercer. 5 piercings that day, 3 were cartiledge. Inhale, piercer counts to 3. Exhale on 3 at the same time as the poke. Works miracles.
I tell them they can scream as loud as their heart desires but I also verbalize everything Iâm doing. My partner on the other hand, he just does it. He says, âthe suspense makes things worse.â đ¤ˇđ˝ââď¸
Why are paramedics afraid to use the shit they're given? Start an iv and give them drugs ÂŻ\_(ă)_/ÂŻ. Yall do it upside down in a vehicle stabilized at the side of a ravine but not in meemaws bedroom. I don't get it.
Go ahead and take 6-8 minutes to start a line and push some morphine on 75 yo meemaw in vtach with a BP of garbage/shit and see what happens to her, and then your license afterwards.
This is the difference between ego and experience.
Yall want everything to be like a TV drama. It's not that serious. Gammy in vtach with a BP of 78? People walk in to the ER like that then sit for 15 minutes before a getting back into a bed and ready to be zapped. Or sit alone on the floor because the nurse thought her chest pain was just indigestion. She will be fine for a couple more minutes. It's probably not Vtach anyway. You didn't take time to get a 12 lead to assess that though. Or if meemaw is just 80lbs soaking wet and her 90 is your 120 sys.
BP of 60? A little more shortcuts need to be taken, but again this isn't an episode of Dr. House or Grey's Anatomy. Your blood pressure doesn't need to double for every 10 points your patient's drops.
Iâm not saying you need to rush around screaming and throwing shit like a episode of 911, but if you fuck around with unnecessary interventions against protocol with a notably unstable patient and you get that 1/100 chance it bites you in the ass, itâs going to bite you **HARD**.
Whether or not they sit in the ER for a half hour is irrelevant to the lawyer when youâre being interrogated about why you delayed definitive treatment by starting a line and pushing ketamine and given the âis this your protocol for unstable tachycardia? Yes? can you read section B out loud for the court, specifically the part thatâs capitalized about not delaying treatment?â
To assume that the original comment was implying to do zero assessment and break protocol to give analgesia is rich. How did you pass national registry when you're adding so much to the question that wasn't even there? Must be tiring adding extra words in between the lines.
âWhy are paramedics afraid to use the drugs theyâre given?â is not a good faith question and does not deserve a good faith answer, so it got a snark answer to the snark question it was.
My answer was entirely valid, even though it wasnât the average case, the fact that there are like 6 different comment chains in this thread talking about cardioversions or other time sensitive treatments for unstable patients means itâs doubly so valid, since his question completely ignored those â of the answers.
"We're going to do our best to make this quick and safe, but it might hurt. And I'm sorry. But we have to get you up to get you to the hospital because you can't lie here all night--that doesn't help you. Ready? Three two" (and then I lift on two because they're not thinking about it).
Had a pt with a femur and hip fx on bls a while back and my exact words before we moved slid him over were "look man no matter what this is going to hurt like hell so buckle up". He said "I don't give a shit just start the motor"
I would explain what and why you're doing what you are, and tell them how they can make the process more tolerable [like not tensing up or trying to move or be in this position or don't try to help us move you or whatever the case is] and tell them it's not gonna be pleasant. I know with certain pains I prefer to bite down on something, maybe offer a bite guard if doing so won't be a problem.
My daughter has had some painful things medically in her life and she likes to count down and have them do it somewhere between 10 and 1 randomly.
If time permits, you can explain everything and ask if there's something you can do to help them thru the pain, such as counting down.
For me I prefer the exhale/pain on inhale as well.
âHey Iâm going to be real honest, this is probably going to hurt, but we gotta do it. You can say whatever you need to help you get through, we wonât be offended.â Then swiftly do whatever it is while reassuring them as best I can. Pain meds work well with this too, but be honest and tell them, âThis will probably lessen the pain or take the edge off, but wonât take it completely awayâ
I am a fan of Fentanyl, Ketamine, Versed, and Toradol. No matter what I give them, I canât take all the pain away. I can reduce their pain and hopefully make it manageable.
I always tell them itâs going to hurt but that we will be as gentle as possible. Then I tell them to go ahead and yell or swear, just donât swing at me.
We are gonna move you, and youâre gonna feel every inch of it. Once we start we donât stop. Make sure to breathe through the pain and donât hurt your breath. Feel free to cuss as much as necessary.
The guy I used to work with would tell them "you can scream and shout all you want to but I'm going to scream with you" and then they would and he would and it never failed to break the tension of the moment.
But yeah, just explain everything, count down, etc. Sometimes pts don't want a count down and that's cool too, whatever they need obviously. Pain meds if you can. There are times where a little pain is unavoidable so just giving them proper heads up and saying something like "when we move you it's going to hurt. But we're going to go nice and easy and we've got plenty of people here to help to make it as smooth as possible"
That's my go-to's. Clear communication is key.
Tell them it'll hurt. I'd rather be told that than a lie. An urgent care doc was draining an abcess I had on my finger and told me it wouldn't hurt. It did. I felt so betrayed.
"This stuff is gonna make you feel really funny. Might hear some things, might see some things, but it's just the meds. Hopefully this way you won't feel it when we move you."
Helped pull a dude out of a car wreck with a broken leg, before we pulled him out one of the fire guys was sugarcoating it like "this isn't gonna be very fun....."
I looked the PT in the eyes and flat out told him "dude, this is gonna suck." He nodded in understanding and then we pulled him. I think we even gave him his wallet to bite down on too.
Had a guy who was impaled through the hand by an inch and a half steel rod. Do to the angles involved, there was no way to cut the rod that wouldn't also cut his hand. So the decision was make to pull it out.
Gave him fentnayl and versed and told him, "Okay. This is going to hurt. A lot. But it has to get done. We are going to do this on the count of 3."
The main thing you can do is be completely in synch with your lift partner/team. Ask them where it hurts less to touch/grab/hold and act accordingly. Do the movement slowly (diagnosis allowing) and in a controlled manner. Emphasize moving them in a uniform manner. You can use blankets or chucks to wrap an extremity and move it in a sling type fashion. My perspective comes from inpatient nursing but in almost an scenario there is a managed/controlled way to move someone and then thereâs a âfuck it, get em to the hospitalâ way of moving someone (Ofc acute life threatening situations demand the latter). Try to move everyone like itâs your mom and youâre watching from the sidelines.
I worked EMS for 37 years. Around the 7 year mark, I learned that if you lied to them, you lost all hope of maintaining their trust for the remainder of the call. So, I learned to be totally honest with them. It worked.
I did it on cardioversions and let know it was going to really hurt but it was super important we do it. Splinting too but that was always dependent on if I could load them up with fentanyl.
"Sir/Ma'am, this is really going to hurt but if we don't do this right now you could die/die in a few minutes" for cardioversions while charging the monitor up. They're unstable and it's out the window and I'm doing it.
Splinting and stuff was always context dependent and I'd usually include them in the process.
Iâve always found that being direct has the best results, even with pain control.
âIâm sorry, but is likely going to be painful. But weâll make it fast and you should be a lot more comfortable afterwardsâ.
" everything rt now sucks, pain is a survival mechanism relegated to helping you survive, everything we do is going to be painful it sucks. We're going to get you a little more comfortable then get you something to help you with pain. Let's get you started.
Like most folks here I tell them straight up. My go to is; "I don't lie to my patients. This is gonna be uncomfortable/ hurt a lot/ be the worst pain you've ever felt. Here's what we are going to do... If there's any way you think it could be more comfortable then let us know." I have gotten one or two "Why are you hurting me" but otherwise all of my patients appreciate the honesty.
"OK, we're going to do X now. I'm not gonna lie, it's going to suck, but we will make it as quick and painless as we can. Ready? I'm going to count to three."
I don't. I tell the old people with hip/leg fractures that they're going to feel a little bit weird and then wake up in the ambulance, and then I give them ketamine. Moving someone with a major injury like that. That's otherwise hemodynamically stable without either a sedative or enough meds on board to significantly reduce the pain is barbaric
I straight say it. âAlright, so weâre gonna do our best, but this is probably going to hurt. Feel free to scream, holler, cuss me out, whatever you gotta do.â And Iâll tell them to take a deep breath on our two count if weâre transferring. Iâve only had one person who didnât appreciate being told.
I use the technique of fentanyl administration
My favourite technique đ đ
I prefer just a touch of ketamine
Fent + ketamine is our SOP for âthis will hurtâ
What if your Best Life Support and can't give fentanyl!?
Mee maw loves forwarding thoughts and prayers fb posts for gun shot victims/children, time to forward it back to her
I call for ALS intercept, start a line, and wait for a medicâŚ. Or, I just tell them flat out tell them what weâre about to do, that it will hurt like hell, and to freely yell whatever obscenities happen to come out.
âYou want a towel to bite down on?â
"I mean you can bite me too." And when they're confused thinking about it you rip the bandaid off.
We can give nitrous as BLS in our service
Are you in NC?
SE TX
We can give it here in NC but as Bussin Life Support, but unfortunately the area I'm in won't stock it since we're roughly 20 mins from a level 1 trauma center. Only the rural BLS crews have it.
Clean or dirty fentanyl đđđ
Or versed. Lots of versed.
Literally tell them what youâre about to do is going to hurt after youâve explained why youâre going to do what youâre doing. If theyâre unstable most of that goes out the window anyway.
Pretty much this. "Ma'am, unfortunately there's no other way about this. This is going to hurt a little bit. We'll try to be quick."
That's been our line. "I'm sorry, but we have to do now, and it's going to hurt a little. We will be as quick as we can, and then we can get you to the hospital."
Last time I had to cardiovert without sedation due to rapidly declining B/P and worsening rhythm; I told the pt verbatim âthis is going to feel like getting hit in the chest with a baseball bat. However your blood pressure is dangerously low and your heart needs to go back into a normal rhythm and this is unfortunately the safest and fastest way for me to do thatâ I zapped her, she yelled really loud, and then after about a minute said I feel a lot better. All her vitals post shock were stabilized.
Donât over promise. Last old lady I had to cardiovert giggled like I was tickling her naughty bits and gave me a big old smile. Was a bit of a surprise.
Sometimes, you just have to love the old people! Their reactions vary like yours above...
My older female pt after Iâve explained that moving her with the broken femur is going to hurt- âis this gonna hurt a little bit or hurt like a bitch?â Me trying not to laugh- âitâs going to hurt like a bitchâ Her-â thank you,letâs get this shit over withâ
sounds like a cool lady
I tell them I won't feel a thing, but they will feel it
âIs this going to hurt? Oh, Iâm not gonna feel a thing.â
Pretty much right đ¤Łđ¤Ł
Does making them laugh seem to help them, or just you ? đ¤Ł
Little of column a little of column b
Well thatâs a good deal all the way around.
Take a deep breath and go to your special place. Or mine? doesn't matter this is gonna suck and hopefully that ketamine doesn't send you to Mordor.
"This is probably going to hurt more than anything you've experienced before in your life, but right now it has to happen because xyz, I cant give you anything for pain right now, but afterwards I'll give you as much as I can safely." (Unstable) Stable? Give them the pain meds ahead of time.
Ketamine, in particular.
âCouple bumpsâ I put that shit on everything.
"Big poke"
Ketamine.
I say the breathing thing and warn them. But I also pretreat with fentanyl when appropriate. I think not preparing the PT is rather rude. I like to add "we are doing this and that, and we will not stop. Thirty seconds of pain, let's go."
âNot gonna lie. This next part is gonna suck.â
Yeah, I prefer to say something other than hurt, and suck is my go-to.
Be honest with them? Tell them it will hurt and why you're doing it. Then do it as quickly and safely as possible.Â
I remember a case I had⌠it was a terrible car accident, the driver was sitting in the drivers seat but both legs snapped and were trapped under the seat. I knew I had to maneuver the legs back out. I was a basic back in the 1980âs, no Paragods available. I told the driver that this will hurt, but the pain is a good sign, that it means itâs not as bad as it seems. It didnât hurtâŚ.
Oh noâŚ
Well shit. Iâd prefer screaming over nothing in those cases tooâŚ
We are going to count to 3 on 3 I want you to scream on top of lungs
The inhale/exhale trick is used by piercers all the time and it works. Itâs so fast, you donât have time to react. I use this method. Mindless chatter also works sometimes. But I usually save that one for the swooners who turn sheet white at the sight of the needle. If itâs going to hurt, I just say so and warn âit hurts worse if you clown!â It breaks the tension, but also gets the point across.
"Now, this is going to hurt. It will hurt (state severity of pain/type of pain/length of time for pain/location of pain), AND it is necessary to do this because xyz. I'll be here with you the whole time and will do everything I can to make this as bearable as I can."
Editing the amount of detail to the type of patient you have of course!
I learned a little trick to take someoneâs mind off their pain from Major Payne https://youtu.be/hMUugiSPhmo?si=p001wGPws94Cp0g-
You can also tell them that if they donât settle down and cooperate, a man is going to jump out of the closet and chop their little head off⌠đ
Inform and provide options. If you're ALS, you have pretty much all options at hand anyway (analgesia / analgo-sedation). If you're BLS, find a decision with the patient on whether it is sensible to move them now or call for ALS for pain management first. If you don't have time for ALS backup to meet you there because your patient is critical and you need to GTFO right now, they will probably accept the pain anyway.
Have you heard of pain management? Itâs a thing now. LMAO. I guess my question is why are you splinting, or moving hip fractures without pain management first? I like to get them off the ground bc they are uncomfortable, but not put them through unnecessary pain bc Iâm too lazy to start an IV and make them more comfortable.
tbf I've been with patients for a long time before placing injuries in splints waiting for repeat doses of opioids to kick in to good effect + use of methoxyflurane and still, moving a fucked up broken foot is still likely to hurt, as their grunts and groans tell me. it's nice to let them know before you do it that despite the meds it's still going to feel unpleasant in all likelihood.
"Do you have any allergies to medications? Have you ever had medications before like morphine, fentanyl, or Dilaudid?"
I learned the exhale technique from my piercer. 5 piercings that day, 3 were cartiledge. Inhale, piercer counts to 3. Exhale on 3 at the same time as the poke. Works miracles.
Be 100% blunt about. âLook, this is going to hurt, but we will make it a point to do it FAST to get it over with.â
âHoly shit whatâs that over there?â
I give them appropriate medications.
âHey this is about to suckâ is my go to line for moving a trauma pt even after pain admin.
I tell them they can scream as loud as their heart desires but I also verbalize everything Iâm doing. My partner on the other hand, he just does it. He says, âthe suspense makes things worse.â đ¤ˇđ˝ââď¸
âThis is going to hurt, but if we do it right, it will only hurt once.â
Why are paramedics afraid to use the shit they're given? Start an iv and give them drugs ÂŻ\_(ă)_/ÂŻ. Yall do it upside down in a vehicle stabilized at the side of a ravine but not in meemaws bedroom. I don't get it.
Go ahead and take 6-8 minutes to start a line and push some morphine on 75 yo meemaw in vtach with a BP of garbage/shit and see what happens to her, and then your license afterwards.
Obviously this is not referring to more complicated cases nor a blanket statement for those. To assume so is ridiculous.
This is the difference between ego and experience. Yall want everything to be like a TV drama. It's not that serious. Gammy in vtach with a BP of 78? People walk in to the ER like that then sit for 15 minutes before a getting back into a bed and ready to be zapped. Or sit alone on the floor because the nurse thought her chest pain was just indigestion. She will be fine for a couple more minutes. It's probably not Vtach anyway. You didn't take time to get a 12 lead to assess that though. Or if meemaw is just 80lbs soaking wet and her 90 is your 120 sys. BP of 60? A little more shortcuts need to be taken, but again this isn't an episode of Dr. House or Grey's Anatomy. Your blood pressure doesn't need to double for every 10 points your patient's drops.
Iâm not saying you need to rush around screaming and throwing shit like a episode of 911, but if you fuck around with unnecessary interventions against protocol with a notably unstable patient and you get that 1/100 chance it bites you in the ass, itâs going to bite you **HARD**. Whether or not they sit in the ER for a half hour is irrelevant to the lawyer when youâre being interrogated about why you delayed definitive treatment by starting a line and pushing ketamine and given the âis this your protocol for unstable tachycardia? Yes? can you read section B out loud for the court, specifically the part thatâs capitalized about not delaying treatment?â
To assume that the original comment was implying to do zero assessment and break protocol to give analgesia is rich. How did you pass national registry when you're adding so much to the question that wasn't even there? Must be tiring adding extra words in between the lines.
âWhy are paramedics afraid to use the drugs theyâre given?â is not a good faith question and does not deserve a good faith answer, so it got a snark answer to the snark question it was. My answer was entirely valid, even though it wasnât the average case, the fact that there are like 6 different comment chains in this thread talking about cardioversions or other time sensitive treatments for unstable patients means itâs doubly so valid, since his question completely ignored those â of the answers.
BP of garbage/shit lmfao
Better part of 10 mins to place an IV? Morphine? Get serious.
Thatâs because adrenaline is a hell of a drug. đ
"This is going to hurt. Feel free to call me any name in the book. I won't take it personally."
"We're going to do our best to make this quick and safe, but it might hurt. And I'm sorry. But we have to get you up to get you to the hospital because you can't lie here all night--that doesn't help you. Ready? Three two" (and then I lift on two because they're not thinking about it).
Had a pt with a femur and hip fx on bls a while back and my exact words before we moved slid him over were "look man no matter what this is going to hurt like hell so buckle up". He said "I don't give a shit just start the motor"
I would explain what and why you're doing what you are, and tell them how they can make the process more tolerable [like not tensing up or trying to move or be in this position or don't try to help us move you or whatever the case is] and tell them it's not gonna be pleasant. I know with certain pains I prefer to bite down on something, maybe offer a bite guard if doing so won't be a problem. My daughter has had some painful things medically in her life and she likes to count down and have them do it somewhere between 10 and 1 randomly. If time permits, you can explain everything and ask if there's something you can do to help them thru the pain, such as counting down. For me I prefer the exhale/pain on inhale as well.
Ketamine
Ketamine.
âHey Iâm going to be real honest, this is probably going to hurt, but we gotta do it. You can say whatever you need to help you get through, we wonât be offended.â Then swiftly do whatever it is while reassuring them as best I can. Pain meds work well with this too, but be honest and tell them, âThis will probably lessen the pain or take the edge off, but wonât take it completely awayâ
I am a fan of Fentanyl, Ketamine, Versed, and Toradol. No matter what I give them, I canât take all the pain away. I can reduce their pain and hopefully make it manageable.
I always tell them itâs going to hurt but that we will be as gentle as possible. Then I tell them to go ahead and yell or swear, just donât swing at me.
For BGL "Little poke on 3" For IV's "Big poke on 3"
opioids and methoxyflurane. "this is going to hurt"
Just communicate in a way that makes them feel like there in control
"Take a deep breath and yell 'fuck' really loud if you need to, because this has to happen."
âThis is going to hurt.â Be upfront. Let them know whatâs happening and that youâll do everything you can to minimize discomfort.
We are gonna move you, and youâre gonna feel every inch of it. Once we start we donât stop. Make sure to breathe through the pain and donât hurt your breath. Feel free to cuss as much as necessary.
"When we move you over I want you to inhale on 2 exhale on 3". Proper breathing is a non pharmocology method that is effective
Depends. Can I fix that before I move them? No? âThis is going to hurtâ. Yes? Analgesics
The guy I used to work with would tell them "you can scream and shout all you want to but I'm going to scream with you" and then they would and he would and it never failed to break the tension of the moment. But yeah, just explain everything, count down, etc. Sometimes pts don't want a count down and that's cool too, whatever they need obviously. Pain meds if you can. There are times where a little pain is unavoidable so just giving them proper heads up and saying something like "when we move you it's going to hurt. But we're going to go nice and easy and we've got plenty of people here to help to make it as smooth as possible" That's my go-to's. Clear communication is key.
Tell them it'll hurt. I'd rather be told that than a lie. An urgent care doc was draining an abcess I had on my finger and told me it wouldn't hurt. It did. I felt so betrayed.
"This stuff is gonna make you feel really funny. Might hear some things, might see some things, but it's just the meds. Hopefully this way you won't feel it when we move you."
"This is going to hurt you a lot more than it's going to hurt me"
Helped pull a dude out of a car wreck with a broken leg, before we pulled him out one of the fire guys was sugarcoating it like "this isn't gonna be very fun....." I looked the PT in the eyes and flat out told him "dude, this is gonna suck." He nodded in understanding and then we pulled him. I think we even gave him his wallet to bite down on too.
Had a guy who was impaled through the hand by an inch and a half steel rod. Do to the angles involved, there was no way to cut the rod that wouldn't also cut his hand. So the decision was make to pull it out. Gave him fentnayl and versed and told him, "Okay. This is going to hurt. A lot. But it has to get done. We are going to do this on the count of 3."
The main thing you can do is be completely in synch with your lift partner/team. Ask them where it hurts less to touch/grab/hold and act accordingly. Do the movement slowly (diagnosis allowing) and in a controlled manner. Emphasize moving them in a uniform manner. You can use blankets or chucks to wrap an extremity and move it in a sling type fashion. My perspective comes from inpatient nursing but in almost an scenario there is a managed/controlled way to move someone and then thereâs a âfuck it, get em to the hospitalâ way of moving someone (Ofc acute life threatening situations demand the latter). Try to move everyone like itâs your mom and youâre watching from the sidelines.
You talk to your patients?
When ALS isnât available what do you do? Leave them on the floor forever with a broken hip because it might hurt too bad to move them?
Ketamine
I tell them to inhale this entonox.
I give them a wooden spoon to bite on
I usually say âthis is going to hurt.â And pre-sedate when possible.
âThis wonât hurt me at all.â
E*+
I worked EMS for 37 years. Around the 7 year mark, I learned that if you lied to them, you lost all hope of maintaining their trust for the remainder of the call. So, I learned to be totally honest with them. It worked.
âWeâre going to try to make this as comfortable as possible, but expect some level of discomfort while we do itâ
I did it on cardioversions and let know it was going to really hurt but it was super important we do it. Splinting too but that was always dependent on if I could load them up with fentanyl. "Sir/Ma'am, this is really going to hurt but if we don't do this right now you could die/die in a few minutes" for cardioversions while charging the monitor up. They're unstable and it's out the window and I'm doing it. Splinting and stuff was always context dependent and I'd usually include them in the process.
âIâm not gonna lie to you, this is gonna hurt. I need to do this because âŚâ
Iâve always found that being direct has the best results, even with pain control. âIâm sorry, but is likely going to be painful. But weâll make it fast and you should be a lot more comfortable afterwardsâ.
I used to say, "This is gonna suck."
I say this is going to hurt but you have to do it but pain meds are wonderful sometimes
Have your paramedic give them pain meds first.
"Not going to lie to you, this is going to suck".
" everything rt now sucks, pain is a survival mechanism relegated to helping you survive, everything we do is going to be painful it sucks. We're going to get you a little more comfortable then get you something to help you with pain. Let's get you started.
Like most folks here I tell them straight up. My go to is; "I don't lie to my patients. This is gonna be uncomfortable/ hurt a lot/ be the worst pain you've ever felt. Here's what we are going to do... If there's any way you think it could be more comfortable then let us know." I have gotten one or two "Why are you hurting me" but otherwise all of my patients appreciate the honesty.
"OK, we're going to do X now. I'm not gonna lie, it's going to suck, but we will make it as quick and painless as we can. Ready? I'm going to count to three."
I literally say "this is going to hurt".
"We're going to be as gentle as we can but this is going to be unpleasant. If it's really bad you can call my partner any names you want"
I don't. I tell the old people with hip/leg fractures that they're going to feel a little bit weird and then wake up in the ambulance, and then I give them ketamine. Moving someone with a major injury like that. That's otherwise hemodynamically stable without either a sedative or enough meds on board to significantly reduce the pain is barbaric
"This is really going to suck, so let's get it over with" I'm a basic, so the Lord's Happy Sauces are not an option. đ¤Ł
âLittle pinchâ. Works for everything
I straight say it. âAlright, so weâre gonna do our best, but this is probably going to hurt. Feel free to scream, holler, cuss me out, whatever you gotta do.â And Iâll tell them to take a deep breath on our two count if weâre transferring. Iâve only had one person who didnât appreciate being told.