Morphine & Phenergan Combo

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CS2000

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Is anyone routinely giving Phenergan as an adjunct to Morphine? Or is Phenergan strictly limited as an anti-emetic in your protocols? I'd appreciate some feedback.
 
CS2000 said:
Is anyone routinely giving Phenergan as an adjunct to Morphine? Or is Phenergan strictly limited as an anti-emetic in your protocols? I'd appreciate some feedback.
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We administer both as Morpine causes N/V at times usually 12.5 mg to 25 mg of phenegran.
 
We can use either or combination, I prefer to give Phenergan prior to administration of M.S., reduces the opioid effect of nausea, and potentiates the effect of Morphine.

I give 12.5 to 25mg phenergan well diluted, sometimes for the sedative effect. ( of course of those <70 years of age)
 
Thanks for the feedback. The ER docs in our System are throwing a fit over the "routine use" of the combo. I've been told that "the routine administration of Phenergan with Morphine (in the absence of nausea/vomiting) is not an acceptable standard of care." Since I wrote the System protocols (that were, of course, approved by a Medical Director), I wanted some feedback to make sure I wasn't losing my mind. I appreciate the information.
 
Many physicians are getting away from phenergan and compazine use and use other H2 blockers or Zofran instead. The psychosis effect, and "burning" of the veins is the main reasons, however if administered properly does a good job. Zofran is good but very expensive as well, does not work well if vomiting has already occurred.

R/r 911
 
CS2000 said:
Thanks for the feedback. The ER docs in our System are throwing a fit over the "routine use" of the combo. I've been told that "the routine administration of Phenergan with Morphine (in the absence of nausea/vomiting) is not an acceptable standard of care." Since I wrote the System protocols (that were, of course, approved by a Medical Director), I wanted some feedback to make sure I wasn't losing my mind. I appreciate the information.
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We use the state of tn protocols. you can find them here it is a pdf file.


http://www2.state.tn.us/health/ems/PDF/Protocols.pdf
 
we set up "narc kits" with phen and ms ready to go in them before we ever leave the wire. but i suppose military medicine is a lot more lenient in those areas than civ med.
 
I wish the ER would have given some to the nice little old lady with a broken arm we had last week. She got the MS, and then proceeded to projectile vomit all over my boots and pants when we moved her into bed at the nursing home. :o
 
Morphine + Phenergan

I made a visit to the ER today due to severe pain caused by two recent car accidents I was in. It was almost worse than the pain of childbirth, and I have three children, all with different labor experiences. I was presribed morphine one time after having ACL surgery on my left knee. I have chronic pain due to 8 bulging and/or ruptured discs in my spine, and was being prescribed Oxycontin for a while. At the time I was given morphine I was weaning myself off of oxycontin and my dr wanted to give me something strong to ensure I was comfortable. The morphine was 15mg, and it didn't work whatsoever. I even took about 8 one night with no effect. So, today at the ER, when the RN offered me a shot of morphine/phenergan to more effectively and quickly reduce my pain, I was hesistant, thinking to myself it would probably be useless to take morphine based on my prior experience. However, she gave me a shot of, what she called "a heavy dose" of morphine with phenergan to help with any possible nausea, and she stated phenergan would help with the effectiveness of the morphine, and that it would take about 25-30 minutes. Within 15 minutes my severe pain was almost gone. I was impressed, and I also had no side effects. I really suggest this combination to anyone having severe pain and heading to the emergency room! Good luck and hope you feel better!
 
We stopped using phenergan about 8 years ago when Zofran gave great results without all the side effects.

Unfortunately, Phenergan recieved bad publicity when given with narcs and demerol ( which we no longer carry as well ). All the blame seemed to be taken by Phenergan.... and many of our docs think its it is the ratio amounts of the two..... but one bad apple out there kinda got it pulled for us. It was a nice alternate drug.
 
A lot of services out this way still carry phenergan. I've given it in combo with MS a few times when the person told me that they usually got very nauseous from narcotics, but still wanted something for pain. Usually I only give 2/12.5 to start and go from there.
 
Phenergan is highly vesicant and has resulted in several high profile cases of necrosis and loss of fingers and limbs when it infiltrated and was not diluted prior to administering IV.

It is not carried around here.
 
We have protocols for it as well. Draw it up and dilute with 10cc NS and push slowly. We are moving to Zofran though, but who knows when that will be.
 
we carry phenergan and morphine.. but i dont typically use either... im a fan of fentanyl!:blush:
 
CS2000 said:
Is anyone routinely giving Phenergan as an adjunct to Morphine? Or is Phenergan strictly limited as an anti-emetic in your protocols? I'd appreciate some feedback.
Click to expand...

In my old service, I use to administer a lot phenergan with morphine. Especially the trauma patient who was fully immobilized. I always had good results. The key is to make sure the phenergan is heavily diluted.

Unfortunately, the State took phenergan off the approved med list and replaced it with Zofran.
 
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