Morphine Administration

rhan101277

rhan101277

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I know many providers are stand-offish about giving pain meds. I think relieving pain is something good. Many folks at my job are proponents of it. Anyhow our protocols say that pain management is indicated on any isolated extremity injury with pain scale greater than 5 out of 10.

I had a guy with a broke/dislocated finger. I have had a jammed thumb before and the pain was bad. Just because it is something small doesn't mean that it is ok to let them ride in pain. I know it was strange for them to call 911 for this but still they are paying and they might as well get some relief. No tachycardia, but grimacing and deformity is easily noticeable.

What do you all think?
 
"Would you like something for the pain?"


If yes, give it. If slapped on the hand for it not being a 5, then everyone in pain becomes a 5.
 
The most common med I push is fentanyl, what do you think? :)
 
I don't withhold pain meds. If I believe my patient is in pain or my patient tells me they are in pain, I will administer them. I will leave it to the ER docs to play the little, "Who's a drug seeker game" .. I personally try not to pass such judgements.
 
I give the meds. Even if they are drug seekers, it's a pathetic little high.
 
medicRob said:
I don't withhold pain meds. If I believe my patient is in pain or my patient tells me they are in pain, I will administer them. I will leave it to the ER docs to play the little, "Who's a drug seeker game" .. I personally try not to pass such judgements.
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This. If they tell me they're in pain, they get something (in the areas I can give narcs anyway [ie NM])
 
I agree, if in pain give meds. See to many medics withholding under the misconception of creating drug seekers. Would like to see Fentanyl on our rigs. Morphine does little for pain management.
 
While MS works for some folks I find that most require a higher dosage to bring the pain down. Also Fentanyl has less side effects than MS esepcially in ACS.
 
I personally have found the opposite. Morphine has more side effects, but works better. Occasionally Fent works well in a patient, but more often than not it doesn't do much.

I have a love/hate relationship with pain meds. I like helping my patients, I hate only having Fentanyl to do it. There are meds that are more appropriate for some conditions, and I hate only having Fent. I would love to have a non-opiate option, along with a couple of other things.
 
Aidey said:
I personally have found the opposite. Morphine has more side effects, but works better. Occasionally Fent works well in a patient, but more often than not it doesn't do much.

I have a love/hate relationship with pain meds. I like helping my patients, I hate only having Fentanyl to do it. There are meds that are more appropriate for some conditions, and I hate only having Fent. I would love to have a non-opiate option, along with a couple of other things.
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Definitely.

We have a frequent flyer with severe, severe gout, and morphine (all we have) is not appropriate. I'd love to give the guy some toradol.
 
Well yes more choices would be nice. I can see if you have only one choice in the toybox looking at what others have may make you want to play with their toys.

What other non-opitates are there? Tordol's my favorite as most of my drug seekers state they are allergic to it.
 
Well yes more choices would be nice. I can see if you have only one choice in the toybox looking at what others have may make you want to play with their toys.

What other non-opitates are there? Tordol's my favorite as most of my drug seekers state they are allergic to it.
 
We have toradol but can only give w/ med control orders for things such as kidney stones, sickle cell crysis etc.

20-40 mg IV push..

Morphine is 2-4mg IV q 3-5 min. up to 10max.
 
emtpche said:
While MS works for some folks I find that most require a higher dosage to bring the pain down. Also Fentanyl has less side effects than MS esepcially in ACS.
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My point exactly. My typical fentanyl dose starts around 75 to 100mcg. Which if you beleive the "opiate equivilency chart" is equivelent to 7.5 to 10mgs of morphine. It is easier to titrate fentanyl because if rapid onset, and it has a better side effect profile overall (not just in ACS) but you can certainly get by with morphine. Just not in the homeopathic doses in most protocols.
 
No way in HECK that is accurate. I've had both Fent and Morphine, and 50mcg of Fent was no where close to 5mg of Morphine.

I remember when I had Morphine I rarely had to use 10mg. I routinely give 50-100mcg of Fent, and have given 200mcg and up multiple times.

I know that is all anecdotal, but I would love to see a side by side real-world comparison study between the two.

Edit: I would believe it if that was talking about Fentanyl patches. When used chronically it seems to work a lot better than when used acutely.
 
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Yes it does have less side effects than MS overall. Berkeley FD did a trial with fentanyl last year focusing on ACS use. Had really good results and the state has done nothing with it since. Ooh data scary medics that can think.
 
Who here is routinely administering Fentanyl via alternative delivery methods such as intranasal or transmucosal on a regular basis? How has your experience been?
 
My medical control authority just changed it's protocols within the last 2 months to include giving Paramedics the authority to give morphine and Fentanyl pre radio. Since giving the two meds I have seen a lot more success with morphine which is the exact opposite of what I expected.
 
Medic785 said:
Who here is routinely administering Fentanyl via alternative delivery methods such as intranasal or transmucosal on a regular basis? How has your experience been?
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We have IN fent here in Victoria. I've only ever seen it work pretty well, but a lot of people don't like it. Its great to have another option.

Anecdotally:
-It provides less pain relief, has a longer onset time, and is more unpredictable (side effects wise) when used in older people. Works pretty fast & well in us young ones.
-Clearing the nose (snorking, blowing, wiping) as much as possible seems to help with the predictability of effect and onset.
-It doesn't have that fast onset like our other two pain relief options. So I think it creates this affect whereby you don't get that moment where the pt says, "Oh that's much better" so you don't feel like its as good.
-You have to be liberal with doses, but they have to be tailored to the person. If you put your IV dose up their nose instead and leave it at that, I suspect that you're unlikely to get much of an affect. Starting max dose in a healthy person is 200mcg here, with subsequent 50mcg doses q5. Problem is you can't give that same set of doses to 83 year old granny who weighs 54 kilos.
 
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