Mike Bjarkoy wrote:
"I need evidence to support the need to withhold Entonox and Nubain from a
patient with and apparent minor head injury to relieve moderate to severe
pain from fractures."
Mike, You will spend a long time looking. this is just another Sacred
Turkey beloved by medical schools and those who have rarely seen a
head-injured patient. It dates from a time when patients were managed by
observation alone and it was considered critical to spot even the slightest
change in concious level. There's no evidence that opiates abolish pupil
reactions, although they may alter pupil size and therefore make the
assessment a little more difficult. They certainly don't make pupils
unequal. Although even nalbuphine can depress respiration, it should not in
therapeutic doses and the need to treat pain vastly outweighs the remote
(and largely theoretical) risks in the sort of patient you are describing.
As with any therapy, the practitioner giving Nubain/Entonox/Opiates etc is
responsible for assessing the effect and maintaining adequate monitoring
until the patient is handed over to another properly qualified practitioner.
Therefore, any adverse effects should be spotted in time. As always, if you
can't control the effects, avoid anything fancy or unpredictable.
Straightening fractured legs with gentle traction and applying a traction
splint is pain-relieving in itself and a topic not covered in training by
some ambulance services (or A&E's for that matter). Although a dose of
analgesic is good before commencing the procedure, it is by no means
essential.
Are there any other Sacred Turkeys list members would like to see killed by
Christmas ? What about witholding analgesia for severe abdominal pain, or
witholding oxygen for COAD patients in acute respiratory failure ?? That
should be enough for now !!
Rob Cocks
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