Blue Balls

I am Jack's blue swollen testicle.

That's what crossed my mind in a fight club-esque narrated voice when I saw the huge blue sphere that once was his testicle, followed by multiple damns and ouches. Let's just roll with it and call him Jack.

Jack had his inguinal hernia operated early this morning and had apparently been running around all day. Jack also didn't quite grasp the concept of rest and, more over, gravity. Resulting in a tennis ball sized swollen and hemorrhaged testicle. Well, at least he was pain free, but he sure isn't going to be doing the dirty anytime soon.

Ouch.

Improvements in pain scoring

In modern medicine there are breakthroughs happening left and right on a daily basis. A new and improved pain scoring technique especially developed for emergent care provider, both pre-hospital and in an ED setting, will now help improve accuracy in pain management and will make the old 1 to 10 visual analogue scale superfluous.

Introducing the

CRAP Score - Cynical Real Alternative Pain Score

CRAP Score = (OPS+AF) x (SC)x (EC)

OPS = 10-point pain score (Old Pain Scale)
AF = Adjustment Factor (see below)
SC = Story Credibility
EC = Exam Credibility

For LPT (Low Pain Threshold) patients; calculate CRAP score:

• If the patient reports their pain as being more than 10 on the conventional 10-point pain scale, subtract 1 point for every point over 10. If a patient claims their pain is 12, subtract 2 points and start with an 8.
  

• For every visit the patient has had to your a&E in the past 12 months claiming a "chronic" or "undiagnosed" painful condition subtract 1 point.

• Every time the patient says "ow" when you push on a non-painful or uninjured area of their body, subtract 1 point.

• For every claimed allergy to a non-narcotic pain relief medication, subtract 1 point.

• If they are wearing sunglasses/wrist-splints/neck-brace/insist on wheelchair/lying down, subtract 1 point.

• If they have tape or ECG lead residue on their body from a prior hospital exam, subtract 2 points. (Waive the wheelchair/neck-brace penalty is the patient is registered with a disability)

For HPT (High Pain Threshold) patients, you add to their reported pain score:

• If a spouse or family member forced them to come in, add 1.

• If patient history shows that every A&E visit for a painful condition related to something torn, broken, ischaemic or perforated, add 2.

• If they have no allergies add 1.

• If they are tachycardic (racing heart) or hypertensive (high blood pressure) add 1.

• If they have visible major injuries they may be in shock and won't feel the true pain till the endorphins wear off

Worked example 1
Young guy/gal goes to A&E for the 7th time in the past year for migraine (-6) reporting his headache as 12 on a 10 point scale (-2). He claims to be allergic to 5 over-the-counter pain meds (-5). He has been to A&E 5 times in the past year claiming other painful ailments e.g. back pain, belly pain, but tests found no disease or injury (-5). He is in the examination cubicle eating crisps/choccy and yelling into his mobile phone. He claims his migraine is a killer. When his abdomen is pressed he claims it is tender (-1), but he hadn't noticed due to the migraine being so bad.
CRAP score = (10 -6 -2 -5 -5 -1) x (0.5) x (1) = -4.5.
Even without Story Credibility of 0.5 and Exam Credibility of 1 that's a CRAP score of -9.

Worked example 2
Limping guy/gal is taken to A&E by spouse, but reports "fuss about nothing" and pain score of 4. Blood pressure and heartbeat are increased (+1). They've taken a couple of aspirin. Examination finds torn ankle ligaments, probable fractured tarsals plus fluid retention around ankle plus abrasions to forehead and forearms. Patient states s/he fell on icy pavement. Patient history over several years shows 3 previous visits for fractures/torn ligaments/open wounds requiring stitching.
OPS + AF = (4 +1 +1 +2) = 7
Even without a Story Credibility and Exam Credibility, that's a CRAP score of +8 and they've sustained real damage.

Found on Dragonqueen's Site, all credits go to her.