Dilaudid

[18G]

Just curious if any systems are using dilaudid on their units. It seems to be the drug of choice here in the ED.

 

[rhan101277]

No, not here.

 

[Melclin]

I'm always interested as to why all these different analgesics seem to be popular in EDs in the states. Whats wrong with morphine?

 

[TransportJockey]

I've never worked in a service that carried them. In NM medics were allowed to use any narcotic but most services only authorized Fentanyl and Morphine. And to be honest with those two I would be perfectly happy

 

[Dominion]

There is a service locally that carries Morphine, Dilaudid, and Fentanyl. Just in case I guess.

 

[18G]

I think EMS services should carry two different analgesics. We only carry morphine which is okay however, if the patient has an allergy to it they are out of luck for pain management which I don't think is right.

I wish we carried Fentenyl as well but we don't.... just good 'ol MS with a pretty conservative protocol.... 2mg every ten minutes to a total dose of 10mg. I think Dilauded is a pretty good drug and have given it many a times. It is much less likely to cause nausea in comparison to MS and has a relatively short duration of action.

 

[Smash]

I think ems should carry as many options for pain relief as possible. That said, I don't know how much added benefit there would be from a third opioid agent if morphine and fentanyl are carried. I'd go for ketamine or a hypnotic instead.

2mg every 10 minutes to a maximum of 10mg? Is that set in stone or can it be varied? That is not a conservative regimen, that's non-existant!

 

[Veneficus]

I think ems should carry as many options for pain relief as possible. That said, I don't know how much added benefit there would be from a third opioid agent if morphine and fentanyl are carried. I'd go for ketamine or a hypnotic instead.

can I come and work for you guys?

2mg every 10 minutes to a maximum of 10mg? Is that set in stone or can it be varied? That is not a conservative regimen, that's non-existant!

that is unfortunately a very common protocol requiring online medical directon to deviate. Might as well do nothing right?

 

[8jimi8]

I think EMS services should carry two different analgesics. We only carry morphine which is okay however, if the patient has an allergy to it they are out of luck for pain management which I don't think is right.

I wish we carried Fentenyl as well but we don't.... just good 'ol MS with a pretty conservative protocol.... 2mg every ten minutes to a total dose of 10mg. I think Dilauded is a pretty good drug and have given it many a times. It is much less likely to cause nausea in comparison to MS and has a relatively short duration of action.

in comparison to what? Dilaudid lasts longer than morphine, and much more powerful.


......Nonproprietary (Trade) Name IM or SC Dose ORAL Dose
Morphine sulfate ..........................10 mg .......... 40-60 mg
Hydromorphone HCl (DILAUDID)......... 1.3-2 mg .....6.5-7.5 mg
Oxymorphone HCl (Numorphan).......... 1-1.1 mg..... 6.6 mg
Levorphanol tartrate (Levo-Dromoran) 2-2.3 mg .....4 mg
Meperidine, pethidine HCl (Demerol).... 75-100 mg..... 300-400 mg
Methadone HCl (Dolophine)............. 10 mg.......... 10-20 mg
* Dosages, and ranges of dosages represented, are a compilation of estimated equipotent dosages from published references comparing opioid analgesics in cancer and severe pain.

 

[MrBrown]

We carried it for a brief period in the late eighties while some hospital services carried nubain or foratol.

That however, was before my time.

 

[ceej]

We carry Dilaudid for IV/IM. It's my go-to analgesic if I'm not worried about B/P issues.

I find it especially effective for kidney stone pain.

Morphine is always a good choice, too.

My beef with Fentanyl is my protocol allows 150mcg q 10 min up to 450mcg before I have to call. I find that not many patients can get adequate control until the ~600mcg range. Dilaudid on the other hand, I almost always have success at 1mg and rarely if ever give another 1mg before the hospital.

 

[8jimi8]

We carry Dilaudid for IV/IM. It's my go-to analgesic if I'm not worried about B/P issues.

And you aren't worried about blood pressure with morphine...?

 

[ceej]

And you aren't worried about blood pressure with morphine...?

I think you misunderstood the quantification of my statement. I'm not going to give someone 2mg of MS with a blood pressure of 80/P

 

[8jimi8]

while we're on the subject...

how much does 1 mg or morphine drops someone's blood pressure?

Is there a reliable estimation? I know everyone is different, but you have those ranges e.g. 1 unit of novolog will drop someones BG an approximate 40 points. 1 unit of PRBCs will cause the HGB to rise by 2 etc...

 

[8jimi8]

I think you misunderstood the quantification of my statement. I'm not going to give someone 2mg of MS with a blood pressure of 80/P

Anecdotally

we had a lady c/o 10/10 crushing, radiating chest pain. BP was 85/60 on LUE.

Pt would go to sleep when you left the room... with a smile on her face... (yah in 10/10 crushing, radiating chest pain)

Ecg was unchanged, CE's were run in the last 24 hours (-) x3 over 18hrs. Stat CE's were (-).

Md and CRT RN were on the floor and I was told to give the morphine anyway.

Pressure didn't drop a bit. (i think i gave her 4) pain went down to a 9.

lol

i think 0-10 for us meant 9-10 for her. So many patients are healthcare savvy now. Especially our population who get "crushing, radiating chest pain" when its too cold to sleep on the street.

They know that all you have to say is I have pain 10/10 and you'll get the feelgood juice... or a couple of 10/325s.


Oh the county... I love workin at the county!

 

[alphatrauma]

while we're on the subject...

how much does 1 mg or morphine drops someone's blood pressure?

Is there a reliable estimation? I know everyone is different, but you have those ranges e.g. 1 unit of novolog will drop someones BG an approximate 40 points. 1 unit of PRBCs will cause the HGB to rise by 2 etc...

That's an interesting question you put forth. I would think that due to variances in physiology from person to person, there is just too much at play to make such an estimate.

 

[ah2388]

one of the services ive rode with carries dilaudid, ms, and fentanyl.

Ive only seen dilaudid used in the ED with great success for all types of pain. With that being said, Ive also found fentanyl given weight based (1-3mcg/kg) to be a very effective analgesic as well

 

[rhan101277]

Anecdotally

we had a lady c/o 10/10 crushing, radiating chest pain. BP was 85/60 on LUE.

Pt would go to sleep when you left the room... with a smile on her face... (yah in 10/10 crushing, radiating chest pain)

Ecg was unchanged, CE's were run in the last 24 hours (-) x3 over 18hrs. Stat CE's were (-).

Md and CRT RN were on the floor and I was told to give the morphine anyway.

Pressure didn't drop a bit. (i think i gave her 4) pain went down to a 9.

lol

i think 0-10 for us meant 9-10 for her. So many patients are healthcare savvy now. Especially our population who get "crushing, radiating chest pain" when its too cold to sleep on the street.

They know that all you have to say is I have pain 10/10 and you'll get the feelgood juice... or a couple of 10/325s.


Oh the county... I love workin at the county!

lol 10/325's

 

[MoonachieFirstAid&Rescue]

In NJ BLS doesnt carry anything.

 

[exodus]

In NJ BLS doesnt carry anything.

BLS doesn't carry anything anywhere, hence the ALS discussion forum?