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timstich
Mar 4, 2004, 3:32 AM
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Since our lovely country makes it nearly impossible to attain decent pain meds, we'll call this whole thing hypothetical.
If you could get it, would injectible novocaine or similar local anesthetic be good to have in say a broken leg situation in the mountains? I've heard professional football players will take the shot to finish a game. Seems like this would be a lot better than administering a systemic anesthetic that makes you groggy and disoriented, albeit happier. What would the pros and cons of this be?
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the_antoon
Mar 4, 2004, 3:41 AM
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i would steal yours then trade it to junky climbers for gear...that would probably be a con
i would therefor get free gear and drugs...and that would be a pro
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timstich
Mar 4, 2004, 3:55 AM
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Yeah right. What junky is going to want a local anesthetic. Dude, I am soooo numb!
Next response por favor...
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freakystyley
Mar 4, 2004, 4:10 AM
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HYPOTHETICALLY -
Novocaine (Procaine) is a short acting agent - might be better off with one of the Amides like (and they can be delivered thru an injectible pen (like epi-pen)) and, some of these are coadministered with adrenaline for added efficacy.
:
Lidocaine (Xylocaine)
Medium (30-60 min)
Mepivacaine (Polocaine/Carbocaine)
Medium (45-90 min)
Bupivacaine (Marcaine)
Long (120-240 min)
Etidocaine (Duranest)
Long (120-180 min)
Prilocaine
Medium (30-90 min)
CNS Toxicity is a major concern with all these, they can do a lot of harm in the wrong doses (cardiovascular collapse, severe allergic reactions, etc). So - you would be sticking your "broken leg" enough to dull the pain that you would be reaching toxic levels in no time. ex - lidocaine is dosed like 7mg/kg - and the minimum toxic dose starts around 19mg/kg - it only lasts what, an hour? the drugs half life might allow some residual agents to build up to that toxic level with each new injection.
I just keep a bunch of percocet, darvocet, etc and some lighter tramadol for the aches and pains - they are systemic, yes, but are needle free, easy to get and dose, and have that oh so appealing recreational use!
that - and they are EASILY traded for gear!
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timstich
Mar 4, 2004, 3:09 PM
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Thanks for the response. I was especially interested about the toxicity levels and the CNS complications. Looks like pills are the way to go.
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tenn_dawg
Mar 4, 2004, 3:57 PM
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I've got a little bit of experience with Lidocaine. I can't see it being effective unless you were able to get it to diffuse through the tissue surrounding your main leg nerve.
Kind of like a ring block, but more localized. It would be really impossible to numb up your entire leg in any other way. The ammount of lydocaine it would take would be staggering. (probably around 60cc of the concentration I used) and I really wouldn't want that much in my system for the reasons listed above.
Keep some pain pills in a medicine bottle, or maybe a joint. Aught to help you out in a tight spot, or at least help you sleep.
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andy_reagan
Mar 4, 2004, 9:46 PM
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I would be especially worried about the complications self administering these doses would give you. Not to mention the communication that would have to happen between you and your friendly emergency rescuer that possibly could fail to happen and prove serious (obviously some meds don't mix well).
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freakystyley
Mar 4, 2004, 10:26 PM
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Exactly - and, being one of those friendly medical guys - I would rather hear a guy say he took 2 vicodin to kill the pain rather than "oh, I injected a local anesthetic of an unknown concentration and quantity -don't really know if it went into fat, muscle, or vasculature ...etc.!"
this is INFORMATIONAL ONLY - Talk to your Doc.
but...if I had to bring a local (hint hint :wink: ) - I might consider this http://www.endo.com/patients/products/lido_faqs.html
again - a local really won't do anything for ya unless you want to rambo-sew a wound together - think about how that stuff is used - to pull teeth, sutures, cyst removal - local stuff. When you are talking compound fractures and busted limbs - give me systemic becasue that kind of pain radiates thru the body! AND keep in mind anything you do to treat yourself might have to be undone by the EMS folks, like cut open your nice stitches or vacuum out your gut!
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climberchic
Mar 4, 2004, 10:32 PM
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In reply to: Yeah right. What junky is going to want a local anesthetic. Dude, I am soooo numb!
Ever heard of Special K???
Cat tranquilizer (Ketamine). People actually take this stuff as a party drug.
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timstich
Mar 5, 2004, 3:34 AM
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In reply to: Keep some pain pills in a medicine bottle, or maybe a joint. Aught to help you out in a tight spot, or at least help you sleep.
I honestly was thinking of others that I might have chance to render aid to. And when it's your friend who is in pain, then I'd do what it took to make them feel better.
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chills
Mar 24, 2004, 8:00 PM
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In reply to: In reply to: Yeah right. What junky is going to want a local anesthetic. Dude, I am soooo numb! Ever heard of Special K??? Cat tranquilizer (Ketamine). People actually take this stuff as a party drug.
Actually there is nothing wrong with Ketamine if administered properly, it is used extensivly in emergency rooms for the elderly and chihldren. It is not a CNS depressent like the opiate based narcotics so it won't depress the resipiratory system. An injection also takes effect within about 3 min so the uptake is quick. It is what is known as a dissociative anasthetic; which as far as I can tell doesn't block pain receptors but kind of makes the brain not associate pain with a bad feeling. It also sounds really trippy which is probably why people take it for fun.....
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tradclimber2
Mar 25, 2004, 7:21 PM
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I would hope that all you 'medical-trained' folks out there would speak up and discourage using 'the needle' for administering anything (except epi-pen). In most states unless you are licensed in that particular state to treat, using a needle for anything is verboten. WFR's can legally administer epi-pens and insulin (only in certain cases, I believe), but cannot administer drugs via needle. EMT's, paramedics, RN's, etc. can only administer under a MD order. Not only can one inject the drug (in this case novocaine) into a vein, muscle, fat, one might also hit a nerve (big bad things happen), or bone (more big bad things), and lets not even mention allergic reactions to meds. )Side note: Lidocaine is also commonly used for arrythmias in cardiac situations - if you use this for an pain killer and accidentally hit a vein, well..........) Also remember, carrying a needle/syringe can not only run the risk of breakage and sticking yourself unwittingly, but many drugs need to be stored refrigerated or they lose their activity - I have not found a way to carry that portable ice chest on a multi-pitch yet.
All us 'medical persons' carry a 'special bag of tricks' (I have my vicodin, abiotics, etc. too), but I would not inject a pain killer - no need to. Use the pill! IF you were in a situation where you could not get to medical aid for MANY HOURS, as in a backwoods situation, hopefully you and your partner do have training to use other routes to ease the pain until help can be sought.
We all know in the back of our minds that 'self-medication' is not 'legal', but we do it anyway - treating another in the same manner could lead to a major problem later.
Ok, this is long and run-on, but the bottom line is: unless you are licensed to administer drugs via needle, best not to do it - use the pill instead.
Ben
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philbox
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Mar 25, 2004, 9:52 PM
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A doctor once told me that pain never killed anyone.
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jhump
Mar 25, 2004, 9:59 PM
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Do you have any idea how fun that would be at a bivy. Shoot up- and keep the Bill Cosby impersonations coming..."O-Ba-Kay-Be."
Better yet, crank out some Bill Murry/Steve Martin skits from Little Shop of Horrors. Wait, that was laughing gas. Better bring that too..."Does this thing scare you? UH-HUH. Get in there!
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studuk2000
Apr 1, 2004, 7:00 PM
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local is useful to have out in the mountains but only for minor procedures, such as to block out a painful toe etc.. using a ring block or local nerve block. would be a waste of time on case of borken leg. not only do you need to be well trained to administer the local to the nerve, without damaging the nerve fibres by the time you have the broken leg the fibres will be hyperaesthesic and unlikely to respond to a standard dose. now if you could do the block and then break your leg it might work then! but doubt that you are that mad to try it and havent tried it myself to find out!
a general body pain relief is required mainly becuase it will work better and is easier to apply. for extreme pain morphine would be my first choice, followed by other opiates such as pethidine, and buprenorphine but you cant get any of these legally but if you do manage to get your hands on some could be very useful! can also use ketamine, but this is an anaesthetic agent NOT pain relief! ok so you wont be concious of the pain but its still there, much different to not feeling it. it is also most definitely halucenogenic so can be used round the camp fire if youre that way inclined
i have to say that my first aid kit is adapted quite nicely to cope with most emergencies, but is sadly lacking in high quality pain relief items, mainly because they are illegal to have. another problem with any opiate is that it will probably sit in your kit for several years or so, so when you get round to using it the active concentration will be unknown, leading to some major headaches for you would be rescuers who will wnat to administer their own fresh stuff. have enough kit though to amputate a leg or such like or deal with major body trauma in a field situation, wont be as sterile as in a hospital but beggars cant be choosers!
would advise you to steer clear of trying to perform heroics even on yourself unless you are either foolhardy or have a lot of training and know what you are doing and have a good understanding of the local anatomy. as long as you can keep yourself or your patient stable doing nothing is probably better than making things worse!
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reno
Apr 1, 2004, 7:14 PM
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In reply to: Ever heard of Special K??? Cat tranquilizer (Ketamine). People actually take this stuff as a party drug.
Yes, they do. And they have frequent violent emergence reactions, including malignent hyperthermia, seizures, tonicity of muscles, rhabomyolosis, etc.
In reply to: Exactly - and, being one of those friendly medical guys - I would rather hear a guy say he took 2 vicodin to kill the pain rather than "oh, I injected a local anesthetic of an unknown concentration and quantity -don't really know if it went into fat, muscle, or vasculature ...etc.!"
Amen, brother. Amen.
In reply to: Side note: Lidocaine is also commonly used for arrythmias in cardiac situations - if you use this for an pain killer and accidentally hit a vein, well..........)
Unless you have a "normal" rhythm of a ventricular foci, injecting the lidocaine into a vein won't do a thing to your heart. The biggest concern with injecting lidocaine into a vein is that of lidocaine toxicity, which is clinically manifested by seizures refractory to benzodiazipine administration. (IOW, you'll have seizures that won't stop.)
In reply to: All us 'medical persons' carry a 'special bag of tricks' (I have my vicodin, abiotics, etc. too), but I would not inject a pain killer - no need to.
Don't quite agree. There are times and situations where an injected analgesic is proper. But I'd not use Lidocaine. Fentanyl Citrate (sublimaze,) Morphine Sulfate (morphine) or Dilaudid (hydromorphone) would be better options.
If you will be doing some remote, long trips, consult with a physician who is well versed in mountaineering. He or she may be willing to write you a prescription for pain medications. It's not illegal to have these drugs. You simply have to follow some DEA regulations.
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leadbelly
Apr 1, 2004, 7:19 PM
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a bit off topic but first aid related....anyone ever use quick-clot?
they issued it in 1st kits when i was in the corps....
great stuff for stopping a good bleeder
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very
Apr 1, 2004, 7:34 PM
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safest and most effective method of pain control for climbing situations:
nature's own green grass-
fast acting, can be used over long periods of time with no toxicity issues, and is a whole lot easier to carry that a syringe( hey if you just broke your anke/leg in a fall, whatever is in your pack is kinda broke too)
also none of the impairment issues associated with high doses of opiates or tranquilizers.
jeesh, how bad has western medicine failed us?
There have been a few solo evacs/rescues that just wouldn't have happened without greeney mcgreen
When do you think we'll see that as a part of the NOLS WMI?
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reno
Apr 1, 2004, 7:37 PM
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In reply to: also none of the impairment issues associated with high doses of opiates or tranquilizers.
That's funny.
"None of the impairment issues..."
Classic.
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taualum23
Apr 1, 2004, 7:57 PM
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Indeed. That is funny. I wouldn't say "none" of the impairment issues. Less, maybe. I'd rather have to deal a little high than completely out on morphine. Now, Morphine is a considerably more effective pain killer. If the s&r guys are there, or someone wlse is helping, why not go for the better painkiller?
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reno
Apr 1, 2004, 8:07 PM
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In reply to: I'd rather have to deal a little high than completely out on morphine.
Thanks for making a critical point for me: If you don't know how to give Morphine properly, you have no business giving it at all. Morphine can and SHOULD be carefully titrated to provide pain relief. You should not give so much that the person is "out."
People can, and do, walk and function in daily life with morphine in their system. It's designed to control pain, not knock the person unconscious.
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timstich
Apr 1, 2004, 11:00 PM
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Hey reno! Glad you finally piped up. You da man...or one of da mans, what knows about this stuff.
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brutusofwyde
Apr 3, 2004, 12:14 AM
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In reply to: Thanks for making a critical point for me: If you don't know how to give Morphine properly, you have no business giving it at all. Morphine can and SHOULD be carefully titrated to provide pain relief. You should not give so much that the person is "out." People can, and do, walk and function in daily life with morphine in their system. It's designed to control pain, not knock the person unconscious.
Yup. I've given my mom morphine a number of times. Simple, accurate eye-dropper titration and she's happier than a clam in mud. Morph would be one of my first choices for ease of untrained accurate administration and potency of pain-killing effect. However, its use is strongly contraindicated where the mechanism of injury dictates monitoring the person's level of consciousness, which in many instances of backcountry trauma, is the case.
Brutus, endomorph
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reno
Apr 3, 2004, 4:01 PM
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In reply to: Yup. I've given my mom morphine a number of times. Simple, accurate eye-dropper titration and she's happier than a clam in mud. Morph would be one of my first choices for ease of untrained accurate administration and potency of pain-killing effect. However, its use is strongly contraindicated where the mechanism of injury dictates monitoring the person's level of consciousness, which in many instances of backcountry trauma, is the case.
Brutus:
You are correct, sir, in that Morphine *IS* contra-indicated when the victim/patient may have an injury that requires close monitoring of the level of consciousness (for example, a concussion.) But in the original post, the question was about an extremity fracture, not a head injury. Assuming the patient is not showing signs of internal bleeding or shock (i.e. pale, clammy skin, rapid heart rate, rapid respirations, lethargy, etc.) then Morphine is the treatment of choice for pain management.
So: you and I agree, in case I wasn't clear. :)
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brutusofwyde
Apr 4, 2004, 6:39 PM
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In reply to: then Morphine is the treatment of choice for pain management. So: you and I agree, in case I wasn't clear. :)
Seemed perfectly clear to me. Nice to have someone who actually knows something about something affirm my semi-hysterical blathering and blind guesses.
And both you, I, and my Mom agree... And Mom's one smart woman (even when she's drooling in her wheelchair) :cry:
Brutus
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