BLSBoy
makes good girls go bad
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In NJ I can't even give it without asking permission.
Why even put this in?<_<
Dilaudid
- Thread starter 18G
- Start date
In NJ I can't even give it without asking permission.
Why even put this in?<_<
medicRob
Forum Deputy Chief
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We have morphine and dilaudid on our rigs. Many services around here discourage carrying multiple narcotics of this caliber unless absolutely necessary given the rise in thefts as of late.
OP
OP
18G
Paramedic
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Had a morbidly obese (500lb) patient last night with a femur fx. ED was giving 1mg of Dilauded IV without much effect on patients pain. Pt. stated the 1mg barely decreased the pain and was rating 8/10 on my assessment with evidence of pain response. Pt. appeared very uncomfortable.
ED doc wanted to give transfer orders of Dilauded 1mg q2hrs PRN. It wasn't making any sense to me to keep doing the same thing over and expecting a different result so I asked the nurse to see about having it changed to 2mg q1hr PRN of which the doc did. Transfer was a little over 2hrs.
So about 15mins into the transfer after I get everything situated patient is still having 8/10 pain that is being exacerbated by the dynamics of the ambulance transport so I give the 2mg Dilauded slow IVP as ordered. Within 10mins pain is slightly reduced, pt. getting sleepy but alert and oriented, hard to hold eyes open.... I'm thinking okay patient had long night, the narc is making her want to sleep. 10-15mins later... highly somnolent, decreased orientation, desaturating, decreased B/P, slight perioral cyanosis developing = NOT GOOD.
I don't want to hit her hard with Narcan so I decided to give 0.2mg Narcan IV... nothing. 5mins later another 0.2 which results in full reversal. Patient is back to baseline mental status and level 9 pain.... ok.. this sucks!
So I call MedComm and explain the case to the doc (who is very cool during the consult) to see what direction she wanted me to go for pain management. Orders are given for 50mcg fentanyl q20-30mins PRN. Patient get's 100mcg over 90mins which brings pain to a level 7 and is tolerable with no adverse effects.
POINTS FOR DISCUSSION:
- I was really surprised that 2mg of Dilauded in a 500lb patient would have the profound and negative effect that it did on this patient. Especially considering that 1mg was barely even scratching the surface.
- Anyone else have any cases like with involving Dilauded?
- I am a strong advocate for pain management for my patients and feel I did the right thing.
- Any other input is appreciated !
ED doc wanted to give transfer orders of Dilauded 1mg q2hrs PRN. It wasn't making any sense to me to keep doing the same thing over and expecting a different result so I asked the nurse to see about having it changed to 2mg q1hr PRN of which the doc did. Transfer was a little over 2hrs.
So about 15mins into the transfer after I get everything situated patient is still having 8/10 pain that is being exacerbated by the dynamics of the ambulance transport so I give the 2mg Dilauded slow IVP as ordered. Within 10mins pain is slightly reduced, pt. getting sleepy but alert and oriented, hard to hold eyes open.... I'm thinking okay patient had long night, the narc is making her want to sleep. 10-15mins later... highly somnolent, decreased orientation, desaturating, decreased B/P, slight perioral cyanosis developing = NOT GOOD.
I don't want to hit her hard with Narcan so I decided to give 0.2mg Narcan IV... nothing. 5mins later another 0.2 which results in full reversal. Patient is back to baseline mental status and level 9 pain.... ok.. this sucks!
So I call MedComm and explain the case to the doc (who is very cool during the consult) to see what direction she wanted me to go for pain management. Orders are given for 50mcg fentanyl q20-30mins PRN. Patient get's 100mcg over 90mins which brings pain to a level 7 and is tolerable with no adverse effects.
POINTS FOR DISCUSSION:
- I was really surprised that 2mg of Dilauded in a 500lb patient would have the profound and negative effect that it did on this patient. Especially considering that 1mg was barely even scratching the surface.
- Anyone else have any cases like with involving Dilauded?
- I am a strong advocate for pain management for my patients and feel I did the right thing.
- Any other input is appreciated !
TransportJockey
Forum Chief
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Oh hey, update... My ILS truck in NM only carries MS and Fent. I am allowed to give Dilaudid, if we carried it. But we don't anymore
slb862
Forum Lieutenant
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We use Fent and morphine. A little Versed at times.
I usually give Morphine 1st, then follow it with Fent., then some Versed if needed.
Dilaudid works great for some things. In the ED they use quite a bit of it. I also have noticed it is certain physicians drug of choice.
I usually give Morphine 1st, then follow it with Fent., then some Versed if needed.
Dilaudid works great for some things. In the ED they use quite a bit of it. I also have noticed it is certain physicians drug of choice.
We carry Dil in some of our more rural rigs, like someone above mentioned apparently it holds some magic capability to handle kidney stone px. Good friend of mine was holding on to a 3.4mm stone that just wasn't moving, 200mcg Fent didn't touch it, 1mg Dil wiped it away!
jjesusfreak01
Forum Deputy Chief
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Do y'all carry Toradol on your rigs? I'm told it works wonders for kidney stone pain...most of the time. I would probably use it first line before moving to narcs, if possible.
Just from what I've seen Toradol is hit or miss for kidney stones. It's never worked for my wife's or some coworkers stones...but I've seen patients that it's worked great for. It looks like to an extent around here dilaudid is taking the place of morphine as the ERs pain drug of choice.
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