1badassEMT-I
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I can!
IM Morphine
- Thread starter Shishkabob
- Start date
I can!
1badassEMT-I
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I have heard of this but I have never heard used in EMS.
usafmedic45
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Who is your medical director? I would like to verify this with him.
Aidey
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Interesting. I was told that epi was put in the lidocaine (or whatever caine) used for local anesthesia because it caused vasoconstriction and reduced the bleeding. I suppose it works for both.
I've seen hospice patients /c a sub-q line for their morphine PCA. We don't have morphine, we have fent, but in either case I can think of a couple of situations where I may use it IM. Hospice, as mentioned above, and also if you are unable to obtain IV access.
I've also used fentanyl IM and IV at the same time for long longer lasting pain control. I think initially we gave 25mcg IV and 50mcg IM, the guy was pretty big with a badly broken/dislocated hip and it was a 45 minute transport.
1badassEMT-I
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See you are just trying to set me off......well not going to happen!
EMSA-Intermediate
Treatment Protocol
5202
Chest Pain/Discomfort
Acute Coronary Syndrome (ACS)
Page 2 of 3
West Virginia Office of Emergency Medical Services - State EMSA-I Protocols
5202 Chest Pain.doc Final 7/28/2006 Revised 4/17/09; 9/11/09
F. If blood pressure < 90 systolic and/or patient is experiencing severe
bradycardia or tachycardia, treat according to appropriate protocol.
Further treatment per MCP orders. If patient has taken sildenafil
(Viagra) or vardenafil (Levitra) within last 24 hours, or tadalafil (Cialis)
within the last 48 hours, nitroglycerin should only be given by MCP
order.
G. Transport.
H. Contact Medical Command.
I. If chest pain persists:
1. Morphine sulfate 2 mg slow IV per order of Medical
Command.
OR
Fentanyl (Sublimaze) 1 mcg/kg slow IV per order of Medical
Command. Note: fentanyl is in micrograms (mcg), NOT
milligrams (mg).
2. May administer additional morphine sulfate 2 mg increments
slow IV OR fentanyl 50 mcg increments slow IV per order of
Medical Command after five minutes if pain persists and BP
is over 100 systolic.
3. Administer additional nitroglycerin 0.4 mg SL per order of
Medical Command.
J. Treat dysrhythmias according to specific protocols.
K. If transport time permits, complete AHA Fibrinolytic Checklist (STEMI). (See
next page).
I do have to get orders for it but can push...also I can provide another protocol for pain management if you like.....
Further more dont mess with me dude!!!!! I like said in the other post I have my opinion and you have yours.....and thats all I got to say to you! ANYMORE you trying to provoke me will be reported .....SO are we done!
Aidey
Community Leader Emeritus
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Whoa there turbo...calm down, please. There is no need to be so confrontational and defensive.
No where in that protocol did it say you can push fentanyl IN (Intranasal), which was the question. No one is trying to provoke you, we're all here learning from each other, and when someone says something unusual it's pretty common to be asked to back that up.
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When stating that morphine and fent can have so much that can go wrong that an IV is somehow required or safer looks like a statement that is trying to start a fight or based on unfounded fear.
I put in the "?" hoping you would clarify the point for me.
1badassEMT-I
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I think me and usafmedic45 has cleared our differences...... it was from another post that tension rose from... but that is water under the bridge for us ........As for the post I was taken it out of CONTEXT from the other post and for that I am sorry!!
1badassEMT-I
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Then state it like that then. Please dont call me a troll and leave it at that......??? does not ask for clarification does it!
Let me ask you this have you ever had a pt to arrest on you after given MS? I have! REASON:: it wasnt because they were allergic either.... They took a OTC called St.John Wort(later when they told me they forgotten he took it) and bad stuff happens when the too meet MS and St. Johns Wort.... without that line I had could have spelled disaster for this pt, had I not got the NARCAN on as fast as I did. My personal feeling and comfort zone is having a line started before pushing my drugs. But that is just me.
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1badassEMT-I
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You are right and I was wrong for misreading the question I tought I saw IM....and it was IN..... and no I cant do IN Fentanyl....only IM/IV....only thing I can push IN is ativan. So I am wrong again sorry for the misread.
Really???
Lorazepam is insoluable in water and uses an oil based solvent, hence cannot atomize effectively.
Midazolam is the only water based benzo available and is often used intranasally.
1badassEMT-I
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As per our protocol 4603
Treatment Protocol
4603
Seizures Page 2 of 2
West Virginia Office of Emergency Medical Services – State ALS Protocols
4603 Seizures.doc Finalized 12/1/01 Revised 4/17/09
7. If seizure lasts longer than 5 minutes or two or more episodes of
seizure activity occur between which the patient does not regain
consciousness:
a. If IV access has been established, administer lorazepam (Ativan) 2
mg IV per MCP order.
b. If no IV access is available, then administer lorazepam (Ativan)
2 mg IM or intranasal (IN) via atomizer per MCP order.
8. If seizure continues, further treatment as ordered by Medical
Command.
E. If patient is not actively seizing:
1. Monitor vital signs closely and be alert for recurrence of seizure.
2. Transport.
3. Perform remaining assessment as indicated.
4. Notify Medical Command
Special note: Diazepam (Valium) may continue to be used via IV or rectal route per previous
protocol until agency stock is depleted. All diazepam must be replaced by lorazepam before
4/17/2010.
Got to have a order from MCP to give it.
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Aidey
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That is a bit strange. We got into this discussion at work a few weeks ago and experimented with some expired Ativan (with our supervisor's supervision) and it absolutely does NOT go through the MAD device we use. The MAD popped off in one case, and in the rest it shot out in a straight stream from the tip of the MAD.
Regardless, do you not believe it improper to administer because of the aforementioned fact?
WV is yet another one of those eastern State's that have antiquated State Protocols.
1badassEMT-I
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I just do as I am told per MCP they hold a way higher CERT than I do!!!!!!!!
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1badassEMT-I
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Dont say that some people here mite blow you up for that statement or think that you may not be train properly! Go to my other post and see what I mean.
Thanks for the advice, but I'm quite capable of holding my own..............I'm not too terribly worried about others "blowing me up".
Many who know me here are aware that I have been properly trained, and more importantly, properly educated.
Your last comment prior to this one actually scares me. It tells me that you will follow any order given by some unknown entity on the other side of a radio. What if the order is wrong? Who do you believe will be the primary defendant when an error in judgement goes to litigation? Do you honestly believe knowledge of your clinical practice holds no importance? Finally, do you REALLY trust the individual on the other end? You have a brain, use it! Think outside of the book. Make your voice heard! Otherwise, the care available to the citizens of your fine State will never change and will not progress with the evolution of medicine. Is that really what you want for yourself, your family, and your community?
Melclin
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This doesn't make any sense.
In what sense did they arrest? As far as I'm aware st John's wort increases the side affects of opiates a little. Was it a respiratory arrest? Then you could simply ventilate the person indefinitely. Did they arrest because they were haemodynamically unstable anyway and the vasodilation that comes with morphine pushed them over the edge? If they were so compromised already, having a line in is irrelevant, they shouldn't have been getting the morphine in the first place and narcan won't help with the vasodilation as far as I know.
Besides Narcan can be given IM (and IN as well) so even if it were going to help, you could still give it without a line.
Nowhere in my education or experience has it been said that naloxone reverses the vasodialatory effect of opiates.
If you're going to be giving medication to a patient it's always nice to have a running IV line but some are simply not good candidates for venous access; small children, neonates, people with no veins, severely shocked patients etc.
A patient that has deep extremity burns for example is going to be a nightmare to get a line into so do you simply not give pain relief?
The most drastic example of this is a guy who was in a car wreck and couldn't get IV access. He got an IO in the humerus, knocked out with fentanyl and ketamine, sux'd and intubated. I bet he had a good time on that ketamine thats for sure!
IN administration is a great option for several medications we carry including fentanyl, midazaolam and naloxone. It's safer (no sharps), easier (no IV access required) and only slightly slower than IV onset times.
Now, if a patient is so bloody crook that a bit of morphine makes them croak then I am seriously worried about anybody who decides that patient should be getting morphine.
If you're going to be giving medication to a patient it's always nice to have a running IV line but some are simply not good candidates for venous access; small children, neonates, people with no veins, severely shocked patients etc.
A patient that has deep extremity burns for example is going to be a nightmare to get a line into so do you simply not give pain relief?
The most drastic example of this is a guy who was in a car wreck and couldn't get IV access. He got an IO in the humerus, knocked out with fentanyl and ketamine, sux'd and intubated. I bet he had a good time on that ketamine thats for sure!
IN administration is a great option for several medications we carry including fentanyl, midazaolam and naloxone. It's safer (no sharps), easier (no IV access required) and only slightly slower than IV onset times.
Now, if a patient is so bloody crook that a bit of morphine makes them croak then I am seriously worried about anybody who decides that patient should be getting morphine.