Pain management in the field

Anxiety relief and pain control using pharmacological agents are critical elements to improving outcome, particularly from the patient's point of view. Careful assessment of the patient and titration of these medications can improve outcomes. In addition to providing pain control, many of the opioids have significant cardiac benefits. The EMS patient record should document any clinical or technical problems during administration of these medications, along with any significant patient events such as nausea and vomiting, respiratory distress, vagal or anaphylactic reaction or diaphoresis, as well as any intervention taken by the paramedic. Monitoring of patients undergoing sedation and pain control, particularly where the patient is at risk for respiratory, ventilatory, oxygenation or hemodynamic changes from the influence of pharmacological agents, which suppress respiration, is vital to the patient's safety. Many such clinical situations occur in settings where standard monitoring equipment is not available or access to the patient and equipment is limited. Monitoring should not be limited to intermittent manual observation. Among the noninvasive methods of patient monitoring, several parameters can provide continuous information on the respiratory effort and subsequent ventilation and oxygenation status of the patient. The paramedics' ability to use, interpret and act upon the data derived from the patient assessment and monitoring technology will help ensure a positive outcome for the patient. Promoting patient comfort and reducing or eliminating pain are the responsibilities of all prehospital clinicians, while at the same time ensuring patient safety.