… Gene Gandy and I drag the first of a few EMS sacred cows to the slaughterhouse in EMS World Magazine.
This month, it's analgesia for abdominal pain.
Look for other closely held dogma and false assumptions to be rudely hacked to pieces in future columns.
One of the issues to worry about with administering opioids to patients with abdominal pain is the fact that opioids are shown to cause the release of serotonin, and this is coupled with the fact that 95% of the body’s serotonin is present in the enteric nervous system. That brings things like paralytic illeus and other complications into play.
Are you aware of any studies where the effects of opioids on the surgery, instead of the diagnosis, have been done?
Haven’t seen any, Ernie.
One of the things I run into is some physicians overly concerned with the effect of morphine and fentanyl on the Sphincter of Oddi. They won’t give anything but Demerol, despite recent studies that show the difference between the three is negligible.
Is this actually still a myth? I thought it was thoroughly debunked shortly after the era of the Cadillac ambulance. I can’t recall hearing this idea even mentioned in over 15 years.
You’d be surprised how many systems are still 15+ years behind the times.
This is getting forwarded to my med-director liaison… seems to happen every time you post an article about modern care… pattern?
As a Virginia paramedic working in the ODEMSA region, last year we *finally* updated all of our protocols. We are now authorized to give Fentanyl to abdominal pain patients. Thank God we finally came out of the Stone Age.
As for slowing down the intestinal tract and causing paralytic illeus–I don’t think our 100 mcg dose is going to be that effective. I work in an ED also, and given the amount of Dilaudid I see given to an abdominal pain patient…yeah, our 100 mcg of Fentanyl isn’t going to cause a lot of issues.
Oh, and we are now also allowed to give Fentanyl to a multiple system trauma patient.