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104 y.o F pt with a midshaft humerus fracture. Unable to elaborate too much on medical history but is tablets for BP, cholesterol, reflux. Unable to get IV access due to ridiculous skin.


How much IM morphine would you give initial and subsequent dosages considering she is in significant pain?
 
the_negro_puppy said:
104 y.o F pt with a midshaft humerus fracture. Unable to elaborate too much on medical history but is tablets for BP, cholesterol, reflux. Unable to get IV access due to ridiculous skin.

How much IM morphine would you give initial and subsequent dosages considering she is in significant pain?
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Keep Nana on the methoxyflurane and ring up for ketamine

Depending on how far away Intensive Care are ... hmm, Brown would perhaps give 4mg IM ... but would really love to avoid the IM route if at all possible, PO ketamine is going to be better.
 
MrBrown said:
Keep Nana on the methoxyflurane and ring up for ketamine

Depending on how far away Intensive Care are ... hmm, Brown would perhaps give 4mg IM ... but would really love to avoid the IM route if at all possible, PO ketamine is going to be better.
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Thanks for the reply. We ended up giving 2x methoxy, 2 x 2.5mg IM morphine. Unfortunately ketamine is a possibility, but not sure whether and IC would have chosen to use it., but we werent oo far from hospital, 3km maybe. Word on the street is that we are getting new skills and drugs shortly including IN fentanyl and ondansetron wafers.

My initial thought was to give 5mg IM straight up. What are peoples views on this?
 
With an elderly like her, I would have stuck with the 2x2.5mg you guys did. MS can affect some geriatrics negatively and I wouldn't want to hit her with the full 5mg
 
I'm going to shoot the next medic from my service that calls for HEMS when they are <20min from TWO Level 1s! Then I'll call HEMS for them so they realize how much freaking longer it takes! How about grow a pair, treat your patient, and get them to the hospital. We run dual medics for cryin' out loud!!
 
PoeticInjustice said:
I'm going to shoot the next medic from my service that calls for HEMS when they are <20min from TWO Level 1s! Then I'll call HEMS for them so they realize how much freaking longer it takes! How about grow a pair, treat your patient, and get them to the hospital. We run dual medics for cryin' out loud!!
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Problems lately? :p I'm used to calling for HEMS... but the last 9 months I've been working rural EMS (in TX it was 300 miles to a LVL1, so we usually stabilized and transported for fixed wing)... So we tend to need it a little bit
 
Chimpie said:
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My first test was bypassing my router, but here is my speeds going through it.

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I am not at all against the use of HEMS and completely understand if you've got some delayed transport times. But we work in a major city with two Level 1s, and many level 3s that are very capable. Our medics are getting into the habit of pulling up on a pretty good trauma and immediately calling for a bird. The worst was a couple weeks ago when a crew called for one 3miles from one of the level 1s
 
the_negro_puppy said:
we werent oo far from hospital, 3km maybe. Word on the street is that we are getting new skills and drugs shortly including IN fentanyl and ondansetron wafers.

My initial thought was to give 5mg IM straight up. What are peoples views on this?
Click to expand...

We can only give IM morphine twice, twenty minutes apart and Brown does not really like IM drugs anyway.

If we are that close to hospital and can extricate her easily Brown would give 3-4mg of IM morphine, keep her on the methoxyflurane and pop her up to hospital
 
Weeeeeeeee we we weeeeeeeeee weeeeeeeee w w weeeeeeee
 
MrBrown said:
We can only give IM morphine twice, twenty minutes apart and Brown does not really like IM drugs anyway.

If we are that close to hospital and can extricate her easily Brown would give 3-4mg of IM morphine, keep her on the methoxyflurane and pop her up to hospital
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I prefer to give fentanyl before morphine.
 
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my protocol is 0.1mg/kg MS04 IM up to 10mg q 10min. i would probably think hard about the repeat dose if i have no IV and would probably give 5mg IM for the previously mentioned lady. I have to admit though I am a "Candy Man" as I am fairly liberal with my pain control compared to the other medics in my area. My goal is a 0.5 on the pain scale.
 
HotelCo said:
I prefer to give fentanyl before morphine.
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Does morphine drop the blood pressure as much as they say in the text books? All my preceptors look at me funny when I prefer fentanyl over morphine. And they say morphine is not a "BP dropper" as the books says it is. Just wondering
 
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