Morphine vs. toradol, kidney stones.

[med51fl]

My department only has the option of morphine for pain management. There are those of us that are pushing for fentanyl, but are having a hard time moving forward with it. The biggest issue for us in regards to pain management is getting the crews to use it. There seems to be an almost absolute avoidance to give anything for pain. The most common excuse is "we were pretty close to the hospital".

Morphine is cheap and IVs are easy I say.

 

[OzAmbo]

The most common excuse is "we were pretty close to the hospital".

Morphine is cheap and IVs are easy I say.

Wow, thats dissappointing... or negligent:sad:

 

[AnthonyM83]

I've given toradol, fentanyl, and morphine for kidney stones. I have to say that toradol seems to provide the longest lasting, more specific relief.

Toradol dilates the ureter while supressing the intense inflammatory response associated with renal calculi. this assists in passing as well as preventing that spasmotic, colicky pain that comes with it. Combined with an alpha blocker, its even better.

Also, in general, 30mg of I.V toradol is equivalent to 10mg of morphine from an analgesia standoint.

Lastly, the constipation that eventually comes with serial doses of opiates only makes the colicky pain worse if they haven't passed it.

I could spend a day reading through a pharmacology book and feel like I kind of learned something, but then I spend a minute reading EMTLife and someone summarize a specific topic and feel like I actually learned something for the day... Thanks.

 

[Melclin]

Supply v demand issue here

Demand outstripped supply so much that services haev put off its ontroduction as the uice wasn't available to be used.

Id almost place bets that once more manufacturing capacity comes online that we may ditch morph completely for fentanyl and hopefully ketamine

I hope not. I don't trust the hospital. You could send them to the market with your favourite cow; tell them to get some real analgesia and you can bet your bottom dollar they'll come back with the magic beans. And not the kind that makes a colles fracture feel better.

I'd prefer to hang onto the lasting analgesia and add to it if possible.

 

[NYMedic828]

We don't have much issue with supply/demand in NYC. Mainly because people almost never treat for pain so it doesn't use up our supply. :unsure:

I wish I could work medic/emt and not have a grumpy old set in their ways never did any self education partner who I have to make decisions with...

If I suggested calling for orders for morphine to my partners they would probably say that's ridiculous we can be at the hopsital in 15 minutes why bother, and they aren't even in that much pain. Also ridiculous because who are you to say what their pain tolerance really is?

My one partner, senior to me, also told someone the other day that etomidate will shut down your respiratory drive after 2 minutes...

Story of my life.

 

[firetender]

A keeper!

I could spend a day reading through a pharmacology book and feel like I kind of learned something, but then I spend a minute reading EMTLife and someone summarize a specific topic and feel like I actually learned something for the day... Thanks.

If we used testimonials, we'd use this!

 

[the_negro_puppy]

The whole "we're nearly at the hospital doesn't fly here.

A 10 minute drive to hospital turns into 20 minutes once we've unloaded and been triaged. This can be another 5-10 minutes if its busy to be allocated and offload into a bed. The nurse then has to do a basic hx and assessment., then beg a physician to write up orders for analgesia. IV access needs to be obtained too if the analgesia is IV. That's on a good day. Most of the time we are 'ramped' (stuck with patients on our stretchers) for 30-60-90-120 minutes at a time. They are still in our care regardless of being at hospital. I've had to start IVs in hospital and give IV morph while ramped as its nearly impossible to get the hospital to give any.

I frequently push more analgesia as we are pulling into hospital if the patient needs it. This is due to the above delays. Pain management is one of the few things we can do that makes a difference in pre-hospital care.

 

[Doczilla]

At least you didn't have a CCRN tell you etomidate was a paralytic

 

[NYMedic828]

At least you didn't have a CCRN tell you etomidate was a paralytic

succinyltomidate?