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September 29, 2008 @ 8:21 pm
A new public video has been posted this week to the various net video services from MedicCast productions. The new program, MedicCast - EMS Shock Simplified, is a short overview of the processes of shock and is part of a new series available over at the MedicCastExtra.com site for EMS providers and students. The EMS Shock Simplified series will cover the three basic types of shock including hypovolemic shock, cardiogenic shock, and distributive shock and will provide basic understanding tips for EMTs and paramedics as well as other medical professionals. Check out the video below and also consider joining the MedicCastExtra.com where you have access to other video learning programs as well as over 300 other study aid files for EMS providers and EMT and paramedic students. September 28, 2008 @ 8:06 pm
Welcome to Episode 137
A podcast for EMT’s, Paramedics, and other medical providers of all kinds. —————————- Sponsored by the MedicCast Extra – Watch the New Extra Tour! Save 10% on Pepid EMS — a revolutionary EMS pocket field guide for providers of all kinds.——–GoDaddy.com for special deals to get your own piece of the internet
BLOCKBUSTER Total Access — activate coupon for $10 off your first month. ——————————– Link of the Week– Emergency Nursing Today Podcast on Shock ——————————— News: COPD Medicines: Risky or Safe? Ohio Keeps Ambulance-Run Data Under Wraps Drug Overdose Deaths on the Rise ———————————- Tip/Trick of the Week – Cardiac Arrest Prevention and Awareness Mayo Clinic on Heart and Artery disease —————————– Med of the Week– Atrovent (Ipratropium) —————————— Comment or share ideas at the MedicCast Forums forums.mediccast.com Rate the podcast at iTunes and help others find the MedicCast Visit the MedicCast Store Get the MedicCast Newsletter — Sign up now — it’s free! Other Podcasts: Contact Me! Call the Voice Mail Line — (941) 306-3342 email me at podmedic@mac.com ———————————————— This week’s Musical Artist – Matthew Ebel and the song “Downtown” Check out Matthew’s songs on iTunes
Click here to check out other Songs from the MedicCast Network Podcasts at the iTunes Store. ————————————– Until next time, Scene safety, BSI! This work is licensed under a September 27, 2008 @ 5:36 am
blubrry.com —————————— I report on this and other EMS news in the most recent episode of the MedicCast News at the Podcaster News Network. Jamie September 25, 2008 @ 7:57 am
——————- Providing pain management via prescribed medications is one solution for helping our patients overcome their pain. The risk/benefit ratio of some pain meds, however, and the fact that giving general anesthesia is overkill requires us to be familiar with other forms of pain management. This is especially true for children. An adult may understand the reason why the pain lessens but doesn’t go away but a child just feels uncomfortable and doesn’t know why. Non-Drug Pain Management According to one pain management survey, only 4 out of 177 nurses used non-drug pain management to assist patients with pain (Wessman & McDonand, 1999). There is certainly room for all nurses and nursing students to invest more time into learning about alternative pain management methods. Methods with strong research backing their efficacy in adults (Tracey et al., 2006):
Which methods translate well to pediatric pain management? Are some more effective or time-efficient than others? Patient Education Having a well informed patient should be every nurse’s goal but with pediatric patients, that may not be practical. Depending on the developmental level of the child, however, some level of understanding of their illness and the causes of their pain may be attainable. Older children can be informed of various pain management methods and may be able to self treat pain. They will be able to understand more complex instructions and be able to follow up on those instructions. Younger children possess varying levels of understanding but even toddlers can be taught to communicate to caregivers about their pain. The key is to devise an instructional program that is age and developmentally appropriate, involves family members or care givers, teaches that pain is manageable through a variety of treatments, encourages open communication regarding intensity and quality of pain. Massage Massage is a time honored intervention used by nurses. There is ample evidence that it is a useful tool for pain management in children when combined as part of an integrated pain management plan (Van Cleve et al., 2004). Massage may range from a foot or hand massage to a back or scalp massage. It is essential to explain what you are planning in terms the child understands such as calling it a “foot rub” instead of a massage. As with many other non-drug pain management interventions, this can be taught and subsequently delegated to other caregivers including family members. Giving this and other tasks to family members may also offer them a feeling of having more control over an out of control situation with their children. Distraction Distraction as a pain management tool encompasses a host of possible interventions. This includes music, guided imagery, game playing, and watching TV. One nurse involved in pediatric pain studies found that the use of distraction was so effective that the research became contaminated by caregivers using it more frequently than called for in the study (Stubenrauch, 2007). It makes sense to anyone who works with kids. They are easily distracted (especially the younger ones). This may explain the mistaken belief dating back to the 60’s that children didn’t experience pain in the same way as adults and therefore didn’t need aggressive pain management (Swafford & Allen, 1968). That children can be temporarily distracted from their pain doesn’t mean that they don’t experience pain or that the pain doesn’t return once the distraction is removed. Distraction has varying levels of effectiveness depending on the patient. It does have the benefit that it can be utilized by every member of the pediatric patient’s care team, including the patient herself. In fact, providing the patient with a choice of distractions may allow for the most effective distraction to be chosen. Distractions that have shown promising results as a pain management intervention include:
The use of this pain management tool is not limited to the treatment of existing and chronic pain. Distraction prior to and during a painful procedure has shown promise in lessening reported and observable pain levels (Stubenrauch, 2007). Conclusions Pediatric pain management requires an integrated approach using a variety of interventions. Non-drug interventions start with patient education to their level of comprehension and follow with massage, and various methods of distraction. Involving the entire care team including family members and friends will improve the effectiveness and response of these methods. A planned approach, documentation of interventions and their effect, and continuity of care between the care team will ensure the best methods for each individual have been used and the goal of adequate pain management has been met. —————— Check out the first article in our pediatric pain series here, Pediatric Pain Assessment Tips for EMTs and Paramedics. Also, listen to this episode on Pediatric Sports Injuries featuring an interview segment with Pediatrician Dr. Mike of the Pediacast podcast.
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—————— Photo Credits
September 21, 2008 @ 11:49 am
Welcome to Episode 136
A podcast for EMT’s, Paramedics, and other medical providers of all kinds. —————————- Sponsored by the MedicCast Extra – Watch the New Extra Tour!  Save 10% on Pepid EMS — a revolutionary EMS pocket field guide for providers of all kindsMedicCast Listener Deals at GoDaddy.com –
BLOCKBUSTER Total Access — activate coupon for $10 off your first month. ——————————– Link of the Week– American College of Emergency Physicians EMS ——————————— News: New Jersey Ambulance Hits Medevac Chopper Ambulance chief defends student For Rescuers, Heroism and Reality Collide ———————————- Tip/Trick of the Week – START Triage Review Start Tutorial and Overview Page —————————– Med of the Week– Morphine Sulfate —————————— Comment or share ideas at the MedicCast Forums forums.mediccast.com Rate the podcast at iTunes and help others find the MedicCast Visit the MedicCast Store Get the MedicCast Newsletter — Sign up now — it’s free! Other Podcasts: Contact Me! Call the Voice Mail Line — (941) 306-3342 email me at podmedic@mac.com ———————————————— This week - Curtis Peoples with, “Back Where I Started” Click below for Curtis Peoples on iTunes
Click here to check out other Songs from the MedicCast Network Podcasts at the iTunes Store. ————————————– Until next time, Scene safety, BSI! This work is licensed under a September 19, 2008 @ 7:39 am
We always hear about how pets prolong lives, help depressed patients, and give companionship, but when they learn to dial 911 I sit up and listen! A dog in Arizona was heard barking in the background after someone (the dog?) dialed 911. Police arrived to find a man starting to come out of a seizure, his faithful dog sitting by his side. —————————— I report on this and other EMS news in the most recent episode of the MedicCast News at the Podcaster News Network. Jamie September 15, 2008 @ 8:15 pm
This past week’s episode of the Nursing Show discussed an overview of three key aspects of pediatric pain assessment. In this article, we’ll cover additional pediatric pain management tips for both working nurses and nursing students, measuring pain levels through:
Let’s go a bit deeper, and look at each of these assessment options in turn along with some links to some additional reference materials and journal articles that might be useful for follow-up reading. Later this week, we’ll follow up with some more information on ways to treat and manage pain in pediatric patients. (Members of the MedicCast Extra and the MedicCast Breakroom will receive an enhanced pdf download of this article.) Children and Pain Choose the one thing that makes children fearful of a visit with a medical practitioner and I’d be willing to bet it’s pain. I have no study to back this one up, just personal experience from my own childhood and from my observations as a parent. Knowing this, I still find it hard to believe that some medical professionals are not more proactive in the management of pediatric pain. Some of this is just entrenched medical convention based on previous articles from long ago. A 1968 article on pediatric pain relief actually said:
As I child who grew up during that time frame, I’d like to have a few words with Swafford and Allen. I believe the issue has been some medical professionals don’t take into account the differences in the ways pediatric patients communicate with their surroundings, as well as the dynamics of adult/child relationships. Thankfully, there has been a broad swing away from the earlier conventional wisdom on pediatric pain towards a more balanced and scientific assessment based approach. The understanding that painful experiences from similar stimuli are not universally measurable from individual to individual has changed medicine’s approach to pain management. Pain is Personal The concept that we all experience pain differently may be hard to comprehend. Why should an injection hurt me more than you. It is the same needle size and technique, right? Other variables aside, the differences lie in each person’s past experience with pain, socio-cultural differences attitudes towards pain, their anxiety levels and experience dealing with anxiety, as well as their individual genetic wiring for pain. When these aspects are taken into account, the concept of accurate pain assessment may seem impossible. Remember, though, that pain is personal. Assessment accuracy doesn’t depend on population averages as vital signs do, but on an individual scale that may be broader or narrower for each patient. Managing pain involves working within that patient’s pain scale. The challenge, therefore, is for the medical professional to remain objective and not impose their pain tolerance or lack of tolerance over the patient’s. Simply assessing and recording pain levels consistently, using the same measurement tools will give the providers the information they need to treat the patient. Children may not be able to understand the source of the pain, may not be able to communicate its level and quality, or respond to adult assessment techniques. Ask any parent: kids are hard to read. The psychological, behavioral, and personality development that changes constantly from birth to early adulthood make all aspects of child assessment difficult and this may be at the heart of the prior standard of care when managing pediatric pain. The goal of medical personnel interacting with pediatric patients should be focused on improving communication of needs either actively or passively through careful observation and interaction. Self Measurement and Assessment Self measurement of pain is the method most are familiar with. Having the individual rate their pain on a scale of 1 to 10 achieves the goal of both measuring the pain and allowing the patient’s personal pain experiences and tolerance to be included in the process. In older children, school age and up, the traditional 1 to 10 scale may be enough to get the pain assessment started, accompanied by careful assessment using the other methods mentioned later in this article. Younger children, meaning young school-age down to older toddlers and preschoolers, may not possess the verbal or cognitive skills to use an abstract numerical scale. A visual measurement scale like the Wong-Baker FACES Pain Rating Scale or the newer Faces Pain Scale-Revised may be used to assist a younger child with self measurement. The choice of scale may not matter as long as the same scale and assessment technique is used consistently for each patient (McCaffrey, 2002). Behavioral Assessment For younger children and older children or adults who are developmentally pre-verbal communicators, an assessment of behavior in response to potentially painful procedures or stimuli is in order. The FLACC scale offers one technique. The FLACC scale is based on a mnemonic device and is scored in a fashion similar to the APGAR score with each value receiving a score of 0, 1, or 2 based on the response or assessment. FLACC stands for:
A score of 0 to 10 is the result, with 0 = little to no pain and 10 = high level of pain. According to the University of Michigan’s pediatric pain assessment site, this scale is effective in assisting with the assessment of children ages 3 months to 7 years. For children younger than 3 months, there are several neonatal assessment scales out there. The Neonatal/Infant Pain Scale (NIPS) is one such tool, another is the Neonatal Pain, Agitation, and Sedation Scale (N-PASS). Both of these tools require the provider to have experience with neonatal assessment in general but use similar behavioral observation approaches as the FLACC scale to assess the child’s level of pain or discomfort. The UCLA Medical School website offers a look at several adult and pediatric assessment tools here. Physiological Assessment This tool is the last tool in the tool box for a reason. Pediatric vital signs are notoriously unreliable markers for tracking early changes in condition. The child’s healthy vascular system and sympathetic response gives them a remarkable ability to compensate for changes wrought by external stimuli such as shock states and pain. The University of Michigan Health System page on pediatric pain management writes:
However, I believe that tracked over time and coupled with the other assessment tools, the use of vital signs as an additional pain indicator is useful. This is supported by the Cleveland Clinic Foundation’s page on pediatric pain as they choose to include physiological assessment as one of the three methods used when assessing pain in children. Pain should be assessed at least as often as each set of vitals. Looking back at correlations between the findings of other pain assessment tools and concurrent vitals signs may offer additional insight into the patient’s overall pain level. Place that information in the context of your current assessment findings along with reports of previous caregivers to determine pain level. Conclusions Pediatric pain assessment requires a toolbox approach. The competent medical professional reaches into the tool box and bring out the tool or tools needed for each child in order to assess the child’s level of pain and to prepare the necessary interventions and medications to manage that pain. Whether those tools include the FLACC scale, the Wong-Baker FACES scale or the Faces Pain Scale - Revised, or the child’s own measurement and description of pain, the caregiver’s understanding and accurate assessment of a child’s pain followed by prompt treatment and follow-up reassessment should be the goal. —————– Check out the next article in our pediatric pain series here, Pediatric Pain Management Tips for EMTs and Paramedics. Also, listen to this episode on Pediatric Sports Injuries featuring an interview segment with Pediatrician Dr. Mike of the Pediacast podcast.
—————— References
Photo Credits
September 14, 2008 @ 8:09 pm
Welcome to Episode 135
A podcast for EMT’s, Paramedics, and other medical providers of all kinds. —————————- Sponsored by the MedicCast Breakroom
Plus
Those features add up to over $85 in value - for how much? Just $5 per monthFind out more on how you can get into the MedicCast Breakroom at MedicCast.com/Break ——————- This week’s episode features this month’s MedicCast Live with our special guests, Lisa Booze and Dr. Craig Corey. The topic this time around was poison control centers and EMS overdose and toxicology issues. Thanks to everyone in the chatroom and who listened in during the live show! Special thanks to our guests: Lisa Booze, PharmD from Maryland Poison Center Dr. Craig Corey, ER physician and inventor of the OxyPhone (an innovative pediatric nebulizer for toddlers) Join us next month for the MedicCast Live, Tuesday, October 14, 2008 at 10PM ET
—————————— Comment or share ideas at the MedicCast Forums forums.mediccast.com Rate the podcast at iTunes and help others find the MedicCast Visit the MedicCast Store Get the MedicCast Newsletter — Sign up now — it’s free! Other Podcasts: Contact Me! Call the Voice Mail Line — (941) 306-3342 email me at podmedic@mac.com ———————————————— Until next time, Scene safety, BSI! This work is licensed under a September 9, 2008 @ 10:39 pm
Announcing the MedicCast Breakroom, a special place for supporters of the MedicCast.The breakroom offers a private members-only location to get the MedicCast podcast delivered. Plus, Breakroom Members get access to these exclusive bonuses not available to the free podcast subscribers: Selected episode tip transcripts from each month (every month, we will pick selected episode transcripts to release to Breakroom members — these are enhanced pdf files with web links to additional resources built-in. A $10 value each month!) MedicCast Store discounts of up to 50% off the regular prices (buy your MedicCast gear for less as a Breakroom member — get your t-shirts, water bottles, MedicCast CDs and more for less. Up to a $25 value on each purchase!) Early access to new products from the MedicCast and its partners (when we get ready to release a new product for the EMS community, Breakroom members will have first dibs on limited edition, signed releases of the products. Up to $50 of added value for limited edition releases!) and now for the priceless part!Breakroom members-only invites to live interviews (sit in online, contribute to the interview via online chat, hear the whole uncut interview before it makes the MedicCast.) Behind the scenes access to the MedicCast (Every month, we’ll host a Breakroom members live discussion about all things EMS. Talk about your recert, ideas for the show and site, EMS in your area. It’s the Breakroom and we’ll talk about whatever you like. Plus - if you can’t make the online session, don’t worry, we’ll send a recording to you in your podcast feed!) ——————————— All of that adds up to more than $85 in value. How much would you be willing to pay all of those extras? More than a fast food lunch? You get all of the Breakroom bonuses listed above for only $5 a month!Get your own private access to the MedicCast Breakroom for 16¢ a day. It is an incredible value, but don’t take my word for it. Try it out for a month and see for yourself! Don’t miss out on your chance to get access to the MedicCast Breakroom! @ 5:42 am
The MedicCast Live is back in action after the summer hiatus. This month’s topic, Poison Control. Join us and our panel of expert tonight! I’m excited about the opportunity to discuss the various ways we can use poison control centers to help us with patient care, community outreach, and our own education on toxins and overdose cases. Here’s how you can join the show live via a computer or by phone: You can also find out how you might be able to win a new MedicCast T-Shirt! The phone and chat lines will be open for your comments and questions. So head on over to Talkshoe.com and check out the show.
Where: Talkshoe.com (MedicCastLive.com) When: Tonight, Tuesday, September 9th at 10 PM ET (7PM PT)
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